Cultures + Broad-Spectrum Antibiotics Within 60 Minutes
Neutropenia: ANC <0.5 × 10⁹/L (or <1.0 and falling)
Fever ≥38°C (or hypothermia in severe sepsis)
Take blood cultures (peripheral + all lumen of CVC)
Pip-tazobactam (piperacillin-tazobactam) 4.5 g IV 8-hourly first-line
Add vancomycin if CVC infection/MRSA risk
Add antifungal if fever persists 48–72h despite antibacterials
Sepsis Six bundle: O2, cultures, fluids, antibiotics, lactate, urine output
MASCC Score
Score ≥21 = low risk; consider oral antibiotics + early discharge. Score <21 = high risk — admit for IV antibiotics. Nurses must know: ANY neutropenic patient with fever = potential emergency regardless of MASCC.
GCC Haematology Context
KFSH&RC and HMC Qatar
King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh and Jeddah, and Hamad Medical Corporation (HMC) in Doha are the premier haematology/oncology centres in GCC. BMT programmes, CAR-T therapy, and clinical trials are available. Many GCC nurses work in these specialist centres.
Sickle Cell & Thalassaemia Complicates Management
High prevalence of haemoglobinopathies in GCC (especially KSA, Bahrain, Oman, Qatar). Patients with sickle cell disease or thalassaemia on hydroxyurea or transfusion programmes who develop haematological malignancy present complex management challenges. Nurses must be aware of baseline haematological abnormalities in these patients.
Blood banking is well-developed in GCC major hospitals. Irradiated and CMV-negative products are available for immunocompromised patients. Platelet availability can be limited in smaller centres — nurses should know escalation pathways for platelet shortage during chemotherapy.
Neutropenic patients require reverse barrier nursing: positive pressure isolation rooms, HEPA filtration, no fresh flowers/plants, low microbial diet (avoid raw vegetables/salads), strict hand hygiene by all visitors. Mucositis care: regular mouth washes, soft toothbrush, antifungal prophylaxis.
Key Exam Points
AML induction = 7+3 (cytarabine 7 days + anthracycline 3 days)
APL = ATRA + arsenic trioxide; DIC risk at diagnosis
ALL = most common childhood cancer; Ph+ = poor prognosis
CML = Philadelphia chromosome t(9;22); imatinib first-line
Hodgkin's = Reed-Sternberg cells; ABVD; B symptoms
DLBCL = most common aggressive NHL; R-CHOP
Myeloma = CRAB criteria
Neutropenic sepsis = EMERGENCY: cultures + pip-tazo within 60 minutes
TLS prevention: allopurinol/rasburicase + aggressive IV hydration
Practice MCQs
1. A patient with AML M3 (APL) is started on induction therapy. The nurse should monitor closely for:
2. A neutropenic patient develops a temperature of 38.2°C. Within what timeframe must broad-spectrum antibiotics be given?
3. Which chromosomal translocation is diagnostic of CML?
4. The CRAB criteria for multiple myeloma stands for: