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Neutropenia febril

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 13 Oct 2025
Last updated: 03 Oct 2025

Summary

Definição

Анамнез и осмотр

Ключевые диагностические факторы

  • quimioterapia recente
  • febre
Полная информация

Другие диагностические факторы

  • idade >65 anos
  • terapia imunossupressora (TI)
  • neutropenia induzida por quimioterapia prévia
  • capacidade funcional baixa (capacidade funcional do Eastern Cooperative Oncology Group [ECOG PS] >1)
  • neoplasias hematológicas
  • doença em estágio avançado
  • esquemas de antibioticoterapia prévios
  • albumina baixa (<35 g/L [<3.5 g/dL])
  • bilirrubina e enzimas hepáticas elevadas (aspartato aminotransferase e fosfatase alcalina)
  • disfunção de órgãos e comorbidades preexistentes
  • baixa contagem absoluta de neutrófilos no nadir do primeiro ciclo (<500 células/microlitro)
  • sinais de pneumonia (tosse, ruídos adventícios, dispneia)
  • dor abdominal
  • náuseas ou vômitos
  • diarreia
  • eritema cutâneo, pele quente, sensibilidade
  • mucosite ou úlceras orais
  • infecção, inflamação ou ulceração das áreas genital e anal
  • cateteres de demora infectados
  • piúria
  • quimiorradioterapia
  • características históricas e exposições recentes
  • sensibilidade do seio nasal
Полная информация

Факторы риска

  • idade >65 anos
  • neoplasias hematológicas
  • albumina baixa (<35 g/L [<3.5 g/dL])
  • bilirrubina elevada
  • enzimas hepáticas elevadas
  • disfunção de órgãos e comorbidades preexistentes
  • quimioterapia recente
  • baixa contagem absoluta de neutrófilos no nadir do primeiro ciclo (<500 células/microlitro)
  • quimiorradioterapia
  • neutropenia induzida por quimioterapia prévia
  • neutropenia persistente (≥7 dias)
  • comprometimento da medula óssea
  • Cirurgia recente
  • sexo feminino
  • capacidade funcional baixa (capacidade funcional do Eastern Cooperative Oncology Group [ECOG PS] >1)
  • doença em estágio avançado
  • terapia imunossupressora (TI)
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • hemograma completo e diferencial
  • testes da função renal (ureia e creatinina)
  • testes da função hepática
  • hemoculturas
  • radiografia torácica
Полная информация

Исследования, проведение которых нужно рассмотреть

  • ensaio molecular de patógenos gastrointestinais
  • urinálise e cultura de urina
  • punção lombar
  • exame para fungos
  • ensaio molecular viral
  • ecocardiograma
  • tomografia computadorizada (TC) do tórax, abdome e pelve
Полная информация

Алгоритм лечения

Острый

alto risco de complicação ou morte: apresentação inicial

baixo risco de complicação ou morte: apresentação inicial

ПРОДОЛЖЕНИЕ

febre persistente além de 3-5 dias de tratamento

Составители

Авторы

Lynne Strasfeld, MD

Professor of Medicine

Department of Medicine, Division of Infectious Diseases

Oregon Health and Science University

Portland

OR

Раскрытие информации

LS is an author of a reference cited in this topic.

Выражение благодарностей

Dr Lynne Strasfeld would like to gratefully acknowledge Dr Kenneth V. I. Rolston, Dr Lior Nesher, Dr Caron Jacobson, and Dr Joseph Antin, previous contributors to this topic.

Раскрытие информации

KVIR has research grants from Merck, Shionogi, and JMI Laboratories for the performance of in vitro studies of novel antimicrobial agents. LN has given two educational lectures sponsored by MSD. CJ and JA declare that they have no competing interests.

Рецензенты

Alison Freifeld, MD

Professor of Medicine, Infectious Diseases Division

University of Nebraska College of Medicine

Omaha

NE

Раскрытие информации

AF has received payment by Merck for work as an adjudication committee member for clinical trials of letermovir. AF has received an investigator-initiated study grant from Merck.

John Wingard, MD

Price Eminent Scholar and Professor of Medicine

Director

Bone Marrow Transplant Program

Division of Hematology/Oncology

University of Florida College of Medicine

Gainesville

FL

Divulgaciones

JW has been reimbursed by Pfizer, Merck, Astellas, and Enzon for speaking fees, fees for educational programs, and consulting.

Matthew Falagas, MD, MSc, DSc

Director

Alfa Institute of Biomedical Sciences

Marousi

Athens

Greece

Divulgaciones

MF declares that he has no competing interests.

Ruth Pettengell, MBChB FRACP PhD

Senior Lecturer in Haematology

Honorary Consultant in Medical Oncology

St George's University of London

London

UK

Divulgaciones

RP has received speaker fees and been reimbursed by Roche, Amgen, Chigai, and Bayer for attending several conferences. RP is a co-author of the EORTC guidelines referenced in this topic.

Agradecimiento de los revisores por pares

Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.

Divulgaciones

Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011 Feb 15;52(4):e56-93.Texto completo  Resumen

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: prevention and treatment of cancer-related infections [internet publication].Texto completo

Klastersky J, de Naurois J, Rolston K, et al. Management of febrile neutropaenia: ESMO Clinical Practice Guidelines. Ann Oncol. 2016 Sep;27(5 suppl):v111-8.Texto completo  Resumen

Smith TJ, Bohlke K, Lyman GH, et al. Recommendations for the use of WBC growth factors: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2015 Oct 1;33(28):3199-212.Texto completo  Resumen

Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America clinical practice guideline update. J Clin Oncol. 2018 Feb 20;36(14):1443-53.Texto completo  Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

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  • Guidelines

    • 2024 update of the AGIHO guideline on diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients with solid tumours and hematological malignancies
    • Prevention and treatment of cancer-related infections
    More Guidelines
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