Neutropenic Fever

We are here again, Dave and I, sitting in a quiet hospital room. It was unexpected. He got really congested and started running fever over the weekend and was diagnosed with a sinus infection on Monday. Our family doctor gave him a shot and prescribed serious antibiotics and offered to admit him to the hospital. Dave declined but agreed to follow up with the oncologist on Wednesday if he wasn't dramatically better. He was still running fever and coughing hard enough to hurt himself on Wednesday so we called the cancer center. We both thought we might be wasting their time and expected to be told that he needed to finish his antibiotics and follow up in a week. That's not what happened.

The oncologist ordered bloodwork and a chest x-ray. The x-ray looked clear but the bloodwork revealed that his immune system is non-existent. His white blood count (WBC) was down to 800; his absolute neutrophil count (ANC) was .7. He was at serious risk for infection (more infection than he already had) so the doctor admitted him with a neutropenic fever.

I wrote a little about how chemotherapy affects the WBC while he was doing treatment. A more serious form of that side effect is a condition called neutropenia, which is an abnormally low amount of neutrophils. Neutrophils make up 50-70% of the body's white blood cells. Common symptoms of neutropenia are fevers and frequent infections, but it also makes common infections present abnormally because the body's normal immune response is supressed. For example, a sore might not develop pus when it becomes infected because the immune system isn't healthy enough to make pus. In the same vein, it can also make the chest x-ray look clear when really, pneumonia might be present. It's tricky like that.

It's fairly common to be hospitalized with a neutropenic fever during chemo treatment, but no one seems to know yet why this happened to him now - three months after treatment. They are running all kinds of blood tests to see if he has any viruses that could cause this drop in his white count. This is our first experience with an infectious disease doctor, so we are waiting to see if he has some weirdo disease. We do know they are testing him for the West Nile virus because he snooped through his chart this morning on the way to his bone marrow biopsy. Yes, he's getting another one of those because cancer is a small possibility but also because the bone marrow can apparently tell a pretty good story about what's happening in the body. They also did a CT scan this morning to look for infection.

Right now, we are waiting for all of those results while he gets IV antibiotics to prevent bacterial infections. They don't seem to think he has a bacterial infection right now because he would be sicker than he is, but like I said, they don't know anything yet. His oncologist sat right in this room this morning and told him, "You are still a mystery." So, we wait for answers and for his WBC to come up to the normal range (somewhere between 4,500 and 10,000).

The good news is - there's always good news - he isn't in excruciating pain after major abdominal surgery and he can eat whatever he wants.

Now I'll wrap up this educational post with a quote. After reading to him about neutropenia last night, he took a few minutes to digest the information and then asked me, "So I have necrophilia?"

No, no he does not. But if you visit, wear a mask because we don't know anything yet.