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Question 2: Unexpected neutropenia in a febrile, but immunocompetent, child
  1. Katie Knight
  1. Department of Paediatrics, Homerton University Hospital, London, UK
  1. Correspondence to Dr Katie Knight, Department of Paediatrics, Homerton University Hospital, Homerton Row, London E9 6SR, UK; katieknight1{at}nhs.net

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Clinical scenario

A previously well 3-year-old girl presents to the emergency department with fever of 38.8°C and reduced oral intake. Aside from a mild tachycardia, which settles with antipyretics, observations are normal, and she is alert and settled. On examination, she is found to have a nasty tonsillitis; she cannot tolerate anything orally, so is admitted to the ward for intravenous antibiotics and maintenance fluids. Routine bloods are sent at the time of cannulation. The laboratory calls to inform you that the full blood count is abnormal; neutrophils are 0.7 and lymphocytes are 1.4.

You wonder if she needs further investigation or treatment for suspected neutropenic sepsis.

Structured question

Should a 3-year-old immunocompetent child with a fever, upper respiratory tract infection and an incidental finding of moderate neutropenia (patient) be treated for suspected neutropenic sepsis (intervention)? Is neutropenia predictive of serious bacterial infection (SBI) in an immunocompetent child (outcome)?

Search strategy and outcome

Secondary sources

The Cochrane library of systematic reviews was searched in May 2015 using the words ‘neutropenia’ and ‘paediatric’. None of the 13 reviews identified were relevant.

Primary sources

MEDLINE, EMBASE and CINAHL databases were searched in May 2015 for the following terms: ‘neutropenic OR neutropenia’ AND ‘child OR paediatric OR pediatric’ AND ‘immunocompetent OR healthy OR incidental’ AND …

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