Version May 2024
| Item | Purpose | Comments |
| Targeted history | Seek sites suspicious for infection | Allows detection of symptoms of infection |
| Physical exam with emphasis on skin, oral cavity, oropharynx, lungs, abdomen, perianal area* | Detection of sites suspicious for infection; guides selection of cultures and imaging | Pain and/or erythema may point to infection; pus is not found due to lack of neutrophils; chest exam may be unremarkable even with pneumonia; abdominal tenderness may suggest neutropenic enterocolitis; perianal or hemorrhoidal tenderness may point to gram-negative or anaerobic infection |
| Complete blood count with differential | Defines the depth of neutropenia | The lower the initial neutrophil count, the greater the likelihood of serious infection or bacteremia; daily counts allow prognostication |
| Creatinine, liver function tests, electrolytes | Defines comorbid conditions | Allows optimal selection and dose of antimicrobial agent(s) and serial monitoring of toxicities |
| Blood cultures (two sets: one peripheral and one from central venous catheter); antimicrobial susceptibility testing | Detection of bacteremia | Fever may be the only sign of bacteremia; allows adjustment of antibiotic regimen if necessary |
| Microbiologic testing from suspected site(s) of infection | Detection of infectious etiology | Bacterial and fungal stains may be helpful; testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is indicated for all patients during the pandemic |
| Imaging studies (generally recommended only if site is suspected from history or exam) | Detection of infectious site | Computed tomography (CT) scans are generally more useful than plain radiographs; pulmonary infiltrates may be inapparent by plain radiography during deep neutropenia and may become manifest only upon neutrophil recovery; thickened bowel walls are seen by CT scan with neutropenic enterocolitis |
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