Archive | 2021
Improving Neutrophil-to-Lymphocyte Ratio With Nutritional Therapy in Chemotherapy-Induced Febrile Neutropenia: A Case Report
Abstract
\n \n \n Febrile Neutropenia (FN) is a serious complicaton of cancer chemotherapy. About 1% of patients with cancer who receive chemotherapy develop FN, which contributes to morbidity and mortality. Neutropenia is characterized by reduced neutrophils below normal, usually occuring7 to 12 days after cancer chemotherapy, where absolute neutrophil count (ANC) of less than 500 cells per microliter in 48 hours. Neutrophil-to-Lymphocyte Ratio is an indicator of inflammatory status that can predict the outcome of FN patients.\n \n \n \n A 69-year-old female patient with Moderate Malnutrition based on Subjective Global Assessment, suffered from Febrile Neutropenia. Seven months earlier she undergone the sixth cycle of chemotherapy due to Rhabdomyosarcoma, with the cyclophosphamide, vincristine, doxorubicin, dacarbazine regimen and lastly 12 days before admitted to hospital. Oral intake decreased due to shortness of breath and loss of appetite. Physical examination showed conjunctival anemia, loss of subcutaneous fat, muscle wasting. Blood tests showed anemia (Hb 7,4\xa0g/dl), leucopenia (360/ul), thrombocytopenia (29.000/mm3), Neutrophil-to-Lymphocyte Ratio/NLR (9), hyponatremia (120\xa0mmol/L), hypokalemia (2,5\xa0mmol/L), hypoalbuminemia (3,0\xa0g/dl). Handgrip dynamometer 5\xa0kg.\n \n \n \n Nutritional therapy was given gradually with a target calorie 1800\xa0kcal and protein 1,4–1,7\xa0g/ideal body weight with regular food and parenteral nutrition. After 14 days of nutritional treatment, the patient was discharged from hospital without shortness of breath, adequate nutritional intake, improved blood test results (leucocytes 1780/ul, NLR 5,24, albumin 3,1\xa0g/dl, Hb 8,9\xa0g/dl, sodium 132\xa0mmol/L, potassium 3,6\xa0mmol/L), handgrip dynamometer 19\xa0kg.\n \n \n \n The success of treatment\xa0in people with chemotherapy-induced Febrile Neutropenia are\xa0influenced by the nutritional status. Febrile Neutropenia patients are in hypercatabolic conditions due to inflammatory process. Neutrophil-to-Lymphocyte Ratio (NLR) reflects an inflammatory response, which will be a predictor of outcome in solid tumors. Nutritional therapy can improve the quality of life and prognosis of chemotherapy-induced Febrile Neutropenia.\n \n \n \n The author (s) received no financial support for the research, authorship, and/or publication of this article.\n