Febrile neutropenia

Overview

• Triple-negative breast cancer: the NHS says call 999 or go to A&E if an adult is breathing very fast, is confused or slurring, has blue, pale or blotchy skin, has a very high or very low temperature or is shivery, or has a rash that does not fade when pressed, and not to drive yourself. Macmillan's earlier signs to ring the 24-hour line: temperature over 37.5 C or below 36 C, shivering, or symptoms of a urine, chest, skin or tooth infection.
• Pancreatic cancer chemotherapy: the NHS says call 999 or go to A&E for breathing very fast, confusion or slurred speech, blue, pale or blotchy skin, a very high or very low temperature, shivering, or a rash that does not fade when pressed. A blocked bile duct or stent is a second route to sepsis in this cancer, so fever counts even when the blood count is normal.
• Bowel cancer chemotherapy: the NHS says to call 999 or go to A&E for breathing very fast, confusion or slurred speech, blue, pale or blotchy skin, a very high or very low temperature, shivering, or a rash that does not fade when pressed. A stoma is a second route to dehydration and infection in this cancer, so fever with a high stoma output counts twice.
• Lymphoma: Lymphoma Action says a common sign of neutropenic sepsis is a temperature above 38 degrees Celsius, and that it is possible to have neutropenic sepsis without a fever, sometimes called cold sepsis, which steroid treatment makes more likely because steroids can mask a fever. For that reason teams also use heart rate, blood pressure, breathing rate and kidney and liver function to check for it. Steroids are part of almost every lymphoma regimen, so the no-fever presentation is not a rarity here.