Defend against Neutropenic Sepsis
18 Jul. 2023
Photo credit Ian Taylor on Unsplash
Neutropenic sepsis is a life-threatening condition that needs urgent treatment. If you or your caregiver suspect neutropenic sepsis, contact your medical team for advice. If it is out-of-hours, treat it as an acute medical emergency and call 999 immediately.
What is neutropenic sepsis?
Neutropenic sepsis is a reaction to an infection, which can happen in patients with neutropenia (a low level of neutrophils in the blood). Neutrophils are a type of white blood cell that work as part of the immune system to fight infection. Having neutropenia makes it harder for the body to fight infection. Neutropenic sepsis is potentially life-threatening and needs urgent medical attention.
Patients most at risk of neutropenic sepsis
Patients are most at risk if they have:
- severe neutropenia (defined as an absolute neutrophil count of less than 0.5 × 109/L)
- long-term neutropenia
- a quick decline in neutrophil count.
Causes of neutropenia
Possible causes of neutropenia include:
- bone marrow disorders, such as myelodysplastic syndromes (MDS), CMML and aplastic anaemia
- treatments that suppress the immune system, such as chemotherapy or immunosuppressant drugs
- stem cell transplantation
Neutropenic sepsis symptoms
If you have any of the following symptoms of infection, you should contact your medical team immediately, no matter how minor or vague the symptoms seem:
- Fever over 38°C, or a low temperature under 36°C
- Chills/feeling cold
- Shivering
- Flu-like symptoms
- Reports of feeling generally unwell
- Agitation
- Paleness (pallor)
- Blotchy skin
- Skin rash
- Cold and clammy skin
- Fast heartbeat
- Quick breathing
- Feeling confused or dizzy
- Nausea and vomiting
- Diarrhoea
- Passing no urine in a day
- Changes in behaviour
Photo credit by Anton on Unsplash
What to do if you suspect neutropenic sepsis
Seek treatment immediately. If you or your loved one show any of the signs or symptoms listed above (no matter how minor or vague the symptoms seem), it's vital that you treat it as an emergency and seek treatment as quickly as you can.
- Call 999 and tell them the patient is neutropenic and you suspect sepsis
- Contact the patient’s medical team for advice
- Try to keep calm
If you feel you're not being heard, don't be afraid to be firm. Even very slight symptoms may require urgent treatment and must not be ignored as infections can develop rapidly.
The National Institute for Healthcare and Excellence (NICE) states
"Management of a person with suspected neutropenic sepsis should include implementation of the 'Sepsis Six' bundle of care within the first hour following recognition of sepsis."
Read more in the NICE Clinical Knowledge Summary on Neutropenic Sepsis
The NHS website explains the 'Sepsis Six' bundle of care developed by the UK Sepsis Trust.
- "The UK Sepsis Trust developed the ‘Sepsis Six’ – a set of six tasks including oxygen, cultures, antibiotics, fluids, lactate measurement and urine output monitoring- to be instituted within one hour by non-specialist practitioners at the frontline. The Sepsis Six Care Bundle as a whole has been shown to reduce the relative risk of death by 46.6 per cent when delivered to patients with severe sepsis within one hour.
Why is neutropenic sepsis such a threat for blood cancer patients?
Having a compromised immune system is often a problem for patients with MDS and CMML, sometimes due solely to their disease, but particularly if receiving chemotherapy or immunosuppressant drugs. During some treatments, white blood cell counts are lowered, meaning the patient’s immune system is compromised and he/she is more susceptible to infection.
Neutropenic Sepsis Pathway
When they first diagnose neutropenia, a patient’s clinical team should clearly explain the risks of neutropenic sepsis, and what to do if it is suspected. They may give the patient (or their caregiver) a form or card headed ‘Neutropenic Sepsis Pathway’ which explains the procedure which is specific to that NHS Trust. Basically this card, (or it could be a form) gives you priority access for hospital admission and treatment, should you show signs of fever or develop flu-type symptoms. It is worth raising the subject of getting a 'Neutropenic Sepsis Pathway' with your Clinical Nurse Specialist or Consultant if they haven’t already discussed this with you, so you can be prepared in any emergency.
Neutropenic sepsis should be treated quickly with intravenous antibiotics, but time is of the essence as these need to be administered as soon as possible.
(See NICE guidelines https://www.nice.org.uk/guidance/cg151)
What steps can MDS/CMML patients take to minimise the risk from neutropenic sepsis?
- Wash hands regularly and thoroughly
- Clean cuts and scrapes immediately with clean water and an anti-septic
- Do not handle animal waste – cat litter boxes etc
- Store and cook food carefully
- Take care of oral hygiene
- Do not share plates/cups or toothbrushes with other people
- Avoid changing the water in flower vases
- Avoid people who have infections or who are sick.
- Avoid crowded places like public transport, festivals and shopping centres.
- Wear protective gloves when gardening and doing housework.
- Keep a thermometer somewhere handy – ideally a digital thermometer which gives a quick, accurate reading.
Neutropenic sepsis – Pam and Tony’s story
Our latest patient story, generously relayed by Pam (surname supplied) to MDS UK Patient Ambassador, Chris Dugmore, is a heart-rending and cautionary account about potential failings, miscommunications and unnecessary delays in getting the right treatment for Pam’s husband, Tony. Sadly, Tony’s MDS progressed to Acute Myeloid Leukaemia and he died at home in March 2023, after three months of unsuccessful hospital treatments for multiple infections. Pam wanted their story told to highlight the real and constant threat neutropenic sepsis presents to blood cancer patients.
