Lung Cancer. Part 6
We should culture quickly and start on some appropriate form of broad spectrum antibiotics. This should be continued until the granulocyte recovery takes place. And granulocyte recovery used to be defined by achieving an absolute number. I think we can substitute for that granulocyte count is increasing on two or three successive days. I think we know that the granulocyte count is rising even if it’s only 500 you are making granulocyte counts, and remember what you see in the peripheral blood is the reserve. It’s what is left over after the granulocytes are mobilized. So I won’t feel quite comfortable for a patient who is doing well with granulocyte count that is going from 89 to 150 to 230 over three successive days, even though they are not at 500. That person is on the way up and if they don’t have a demonstrated site of infection that requires continued antibiotics appropriate for that infection, if nothing else has been cultured - and that’s usually what happens - nothing astounding in the culture, I think you can stop antibiotics safely at that point. Obviously if they have a positive culture or a demonstrated site of infection you need to give a course of therapy which is appropriate for that site of infection.
If you have cancer patients who have a fever and the granulocyte count is at a healthy level and is not falling rapidly, these patients could be managed like anybody else with a fever who comes for medical attention. Keep in mind that patients with cancer may have fevers as a result of drugs. Bleomycin, for example, they may have fevers as a result of the underlying disease, including lymphomas and renal cell cancers with liver metastases, or they may have reactions to blood products. Large differential. But you can walk not run to the nearest exit the situation if the granulocyte count is in good range.
Lung cancer