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A.     Fever

Fever is one of the most common and obvious signs that allows the clinician to presume that the patient is sick. The measurement of temperature is an approximation and can be taken orally, axillary, or by tympanic measurement; however, fever is defined as a single oral temperature above 38.3 C (101 F) or a temperature of 38.0 C or greater taken on two occasions at least 1 hour apart. Do not take rectal temperatures in patients with neutropenia.

B.     Neutropenia

Severe neutropenia is defined as ANC < 200/uL [total leukocytes x (% neutrophils + % band cells)]; moderate neutropenia is 200-500/uL; mild neutropenia is 500-1000/uL. The risk for a serious infection in a child being treated for cancer is directly related to the degree and duration of neutropenia. The risk for bacteremia/septicemia escalates when the absolute neutrophil count (ANC) is < 200/uL, while the risk for serious infections (including pneumonitis, cellulitis, and abscess) begins to increase when the ANC falls below 500/uL. Those patients whose course of neutropenia is brief (ANC > 500/uL within 7 days after fever) have a better clinical response than those who remain neutropenic (ANC <500/uL) more than 7 days.

C. Indicators of marrow recovery

An increase in circulating monocytes, an increase in platelet count, and the presence of young myeloid precursors, toxic granules, and Dohle bodies may reflect marrow recovery. Some use an absolute phagocyte count [total leukocytes x (% neutrophils + % bands + % monocytes)] as a predictor of recovery.