February 2003

Should a patient undergoing treatment for acute leukemia or who has recently undergone a stem cell transplant present in the emergency room for fever, please assess patient, proceed with the following investigations and initiate broad spectrum intravenous antibiotic coverage as recommended below. Please inform the BMT physician on call of the patient. They can be reached 24 hours a day by calling Vancouver General Hospital locating at 604.875.5000, the Vancouver General Hospital inpatient ward at 604.875.4343 or the BC Cancer Agency's Vancouver Centre inpatient ward at 604.877.6098 ext. 2601.

Investigations:

• Complete physical examination
• CBC (including differential and platelet count)
• Electrolytes, urea, creatinine and liver function tests
• Blood and urine cultures
• Chest X-ray, oxygen saturation

Antibiotics:

• Option 1: Vancomycin, Tobramycin and Ciprofloxacin
• Option 2: Vancomycin, Tobramycin and Ceftazidime

Consideration should be made for admission especially for those who are hypotensive and/or unable to tolerate oral hydration. The differential diagnosis for fever in this population of patients is broad and includes bacterial, fungal and viral infections.

(Prepared by Dr. Kevin Song and the Leukemia/ Bone Marrow Transplantation Program of British Columbia.)