Neutropenia and Fever

These instructions are for Children's Hospital of Philadelphia (CHOP) patients with neutropenia to learn what to do if they have a fever.

Important information:

Neutropenia is a disorder that causes children to have lower than normal levels of neutrophils in the blood. Neutrophils are a type of white blood cell (WBC). Neutrophils protect the body against bacterial infections. Neutropenia can be a very serious condition because children tend to get infections more easily. Learn more about the causes, symptoms, diagnosis and possible treatment options for neutropenia.

Infections

The risk of infection is greater when the neutrophil count is low, usually below 500. The types of infections that may be seen are:

  • Ear infections

  • Tonsillitis

  • Mouth ulcers

  • Gum infections

  • Skin infections (bacterial and fungal)

  • Belly button infections

  • Urinary tract or bladder infections

  • Abscesses

Possible signs of infections

  • Fever

    • 1x greater than or equal to 38.3° C or 101° F

    • 3x greater than or equal to 38° C or 100.4° F in 24 hours

  • Shaking chills

  • Abnormal discharge or pus

  • Painful or difficulty swallowing

  • Unusual redness, swelling or warmth on the skin

In cases of neutropenia and severe infection, a fever may be the only symptom. Any infection can be life-threatening, especially for individuals with very low neutrophil levels.

Patient instructions for preventing infections:

  • Handwashing is the very best way to prevent the spread of germs and infections. Wash hands frequently with soap and water.

  • Keep the body clean by showering or bathing regularly.

  • Clean your teeth, gums and mouth every day. Use an antiseptic mouthwash.

  • Stay away from people who are ill.

  • Get prompt medical attention for any injury.

  • Ask your hematology team before getting any vaccines.

  • Do not use antiperspirants. You may use deodorant. Antiperspirants will not allow the body to sweat, and bacteria gets trapped within the body.

  • Menstruating patients with neutropenia should consider using pads (sanitary napkins) instead of tampons during their period. Pads reduce the risk of toxic shock syndrome.

  • Attend all scheduled lab and follow-up appointments.

Patient instructions for fever:

Caregivers of children with neutropenia need to be aware of fevers and their dangers. Follow the fever guidelines set by your hematology team.

Call your hematology team right away if your child has a fever:

  • 1x greater than or equal to 38.3° C or 101° F

  • 3x greater than or equal to 38° C or 100.4° F in 24 hours

When your child has a fever

  • Do not take their temperature rectally. If your child is old enough, take their temperature by mouth. If your child is young, take their temperature under their arm (axillary).

  • Do not give medicine to bring down the fever, such as acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®) until your hematology team says it is ok to do so. These medicines make it difficult to identify an infection.

  • Keep your child lightly dressed. Heavy blankets and clothing can cause their temperature to go higher.

  • Encourage your child to drink plenty of fluids.

  • Do not give alcohol baths. They are dangerous.

  • Do not give your child aspirin.

Treatment

When your child has an unknown source of fever, you'll be advised to take them to the Emergency Department for further tests. These tests include a complete blood count (CBC) and a blood culture.

  • The CBC will show if your child is neutropenic, based on the absolute neutrophil count (ANC).

  • The blood culture is done to check if bacteria is causing the fever.

  • IV antibiotics are given to cover a wide range of possible bacterial infections until the blood culture results are available. One common antibiotic used is ceftriaxone. They may need to stay briefly in the hospital or the Emergency Department.

  • If the blood culture identifies a specific bacteria, your child will need a full course of antibiotics.

  • If your child is diagnosed with a viral infection, please follow the instructions provided by your hematology team.

Contact your CHOP hematology team with questions or concerns:

Division of Hematology

215-590-3535

CHOP Main patients:
8:30am-5:00pm, Monday-Friday
215-590-3437

Voorhees patients
8:00am-4:30pm, Monday-Friday
856-435-7502

King of Prussia patients:
8:00am-4:30pm, Monday-Friday
267-425-3320

Weekends, holidays and every day after
5:00pm, all patients: 215-590-1000, ask the
hospital operator for the hematologist on call.

For non-urgent issues, send your team a message in the MyCHOP portal.

 

Reviewed on June 1, 2023, by Grace Nelson, CRNP