AMBOSS defines febrile neutropenia as ANC<500 https://next.amboss.com/us/article/KJ0UES?q=febrile%20neutropenia#2b1TG20
@smitterb is UWorld saying “severe neutropenia <500” or “severe febrile neutropenia is <500” as the edit would imply
Hi! The pt in the question had an ANC of 690. This is what they say:
“This patient is febrile with no obvious focus of infection given the normal chest x-ray and urinalysis. He has febrileneutropenia (FN). Neutropenia is defined as an absolute neutrophil count (ANC) <1500 neutrophils/mm3 (severe neutropenia is ANC <500 neutrophils/mm3). Patients with ANC <1000 neutrophils/mm3 (as in this patient with ANC = 690 leukocytes × 20% neutrophils = 138 neutrophils/mm3) are at higher risk for overwhelming bacterial infection due to an absent or blunted neutrophil-mediated inflammatory response.”
@Ahmed7 @herstein.jacob @shmuelsash @Sameem @StanG Any input on how to handle this card? Some disagreement in wording for defining neutropenia between AMBOSS and UWorld
AMBOSS defintion: “Neutropenia: ANC < 500/mcL OR expected to decrease to < 500/mcL within 48 hours”
Here is what NLM-NIH-statpearls says:
Neutropenic fever is defined as a single oral temperature greater than or equal to 101 F (38.3 C) or a temperature greater than or equal to 100.4 F (38 C) for at least an hour, with an absolute neutrophilic count (ANC) of less than 1500 cells/microliter. In most cases, the infectious etiology cannot be determined and gets marked as a fever of unknown origin (FUO). In severe neutropenia, the absolute neutrophil count (ANC) is less than 500 per microliter. Febrile neutropenia is the most common serious and common complication of cancer therapy.
I guess UWorld uses this definition directly.
Personality I’d go with UWorld, I don’t completely trust Amboss, lot of discrepancy with UpToDate and NLM as well.
As usual mention in extra that this card previously said… and also the discrepancy with Amboss.
Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America | Clinical Infectious Diseases | Oxford Academic - this is the AMBOSS source. JAMA and BMJ agree (< 500). Definition varies across institutions. I don’t support changing anything yet
I think it is the confusion between Neutropenia (in general) and Febrile Neutropenia (as a separate diagnosis). We can mention it in extra that severe != febrile. But febrile = fever + ANC<500
This from dynamed
@Ahmed7 @herstein.jacob @shmuelsash @Sameem @StanG Take a look back at this whenever you all get a chance, felt we shouldn’t edit Text based on discussion above so I opted to add a note to Extra instead. Thumbs up here if we’re ready to push 
If anyone can figure a way to debulk the extra a bit, be my guest