What are the indications for referring a patient with neutropenia to a specialist?

Indications for referring a patient with neutropenia to a specialist include:

• Suspected neutropenic sepsis in patients undergoing anticancer treatment who become unwell requires immediate referral for assessment in secondary or tertiary care as an acute medical emergency ¹.
• Patients with neutrophil count of 0.5 × 10⁹ per litre or lower accompanied by a temperature higher than 38°C or other signs or symptoms consistent with clinically significant sepsis should be referred urgently ¹.
• Patients with neutropenia who have risk factors for sepsis such as immunosuppression due to illness or drugs (including chemotherapy, long-term steroids, immunosuppressants), recent surgery or invasive procedures, breaches in skin integrity, or indwelling lines or catheters should be considered for specialist referral ².
• Patients receiving high-intensity chemotherapy expected to cause severe neutropenia (0.5 × 10⁹/l or lower for 7 or more days) should have documented clinical care policies involving haematology and oncology specialists, implying referral for specialist management ³.

Summary: Immediate referral is indicated for any patient with neutropenia and suspected sepsis, especially those on anticancer treatment or with significant risk factors for infection. Patients with severe or prolonged neutropenia due to intensive chemotherapy also require specialist involvement ¹,²,³.