Sepsis

Sepsis may be the presenting complaint in a patient with undiagnosed leukaemia. Fever or another symptom of infection are also the commonest reason for a patient with known leukaemia to present to emergency services. Leukaemia patients are immunosuppressed, even if they have a normal neutrophil count.

Patients with an infection should be started on broad spectrum intravenous antibiotics and discussed with haematology.

Some specific factors to bear in mind when treating infections in known leukaemia patients include:

1. Resistant organisms. Patients have often had multiple previous antibiotics and may be colonised with resistant bacteria, influencing empirical antibiotic choice¹³. Check microbiological records and consider discussion with a microbiologist.
2. Indwelling lines. The possibility of line infection should be considered in all patients with a line. The stereotypical history of fever after line use is not always present. The addition of a specific gram-positive antibiotic (such as vancomycin or teicoplanin) can be considered, in addition to broad spectrum therapy¹³. If the patient is unwell consider emergency line removal, after discussion with the haematologist.
3. G-CSF. In the context of acute myeloid leukaemia, G-CSF is theorised to drive the underlying malignant clone and therefore is generally not used.