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Risk of infection in children with fever and non-chemotherapy-induced neutropenia

Nabil M Ahmed, MD, MPH
Debra L Palazzi, MD, MEd
Section Editors
Morven S Edwards, MD
Donald H Mahoney, Jr, MD
Deputy Editor
Mary M Torchia, MD


Fever may be the first manifestation of a life-threatening infection in the neutropenic child, particularly one with a primary hematologic disease such as severe aplastic anemia or congenital neutropenia. Because of important differences between hematology and oncology patients with neutropenia, the risk of infection in hematology patients with different types of non-chemotherapy-induced neutropenia and fever are reviewed here. The management of fever and neutropenia in these patients and in children with chemotherapy-induced neutropenia are discussed separately. (See "Evaluation and management of fever in children with non-chemotherapy-induced neutropenia" and "Fever in children with chemotherapy-induced neutropenia", section on 'Definitions'.)


Generally, neutropenia is defined as an absolute neutrophil count (ANC) <1500 cells/microL. The ANC is calculated using the following formula:

ANC = total white blood cell count (cells/microL) x (percent neutrophils + percent bands) ÷ 100

Recognizing that the definition of a normal ANC varies with age and race is important. The lower limit of normal for the ANC in infants between two weeks and six months of age is lower than that for the older child (1000/microL versus 1500/microL) [1]. Also, normal neutrophil values for people of African descent are lower than those for Caucasians [2].

The degree of neutropenia is classified as follows:

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Literature review current through: Nov 2017. | This topic last updated: Oct 25, 2017.
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