Can I Do a Rectal Exam in a Neutropenic Patient?

  • Chad Mosby
  • Matthew P. BorlozEmail author


Patients with pathologically low neutrophil counts, or neutropenia, can present a diagnostic and management challenge in the emergency department (ED). One diagnostic tool, the digital rectal exam (DRE), has historically been discouraged in neutropenic patients due to the concern that it may lead to bacterial translocation and subsequent bacteremia; however, evidence to support this position is lacking. Certain circumstances may justify its use if other lower-risk testing modalities are not readily available.


Neutropenia Neutropenic fever Rectal exam Anorectal 


  1. 1.
    Hsieh MM, Everhart JE, Byrd-Holt DD, Tisdale JF, Rodgers GP. Prevalence of neutropenia in the U.S. population: age, sex, smoking status, and ethnic differences. Ann Intern Med. 2007;146:486–92.CrossRefGoogle Scholar
  2. 2.
    Schouten HC. Neutropenia management. Ann Oncol. 2006;17(Suppl 10):x85–9.CrossRefGoogle Scholar
  3. 3.
    Dale D, Welte K. Neutropenia and neutrophilia. In: Kaushansky K, Lichtman M, Prchal J, Levi M, Press O, Burns L, et al., editors. Williams hematology. 9th ed. New York: McGraw-Hill; 2016. p. 991–1004.Google Scholar
  4. 4.
    Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant. 2009;15:1143–238.CrossRefGoogle Scholar
  5. 5.
    Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52:e56–93.CrossRefGoogle Scholar
  6. 6.
    Grewal H, Guillem JG, Quan SH, Enker WE, Cohen AM. Anorectal disease in neutropenic leukemic patients. Operative vs. nonoperative management. Dis Colon Rectum. 1994;37:1095–9.CrossRefGoogle Scholar
  7. 7.
    Boddie AW, Bines SD. Management of acute rectal problems in leukemic patients. J Surg Oncol. 1986;33:53–6.CrossRefGoogle Scholar
  8. 8.
    ASGE Standards of Practice Committee, Khashab MA, Chithadi KV, Acosta RD, Bruining DH, Chandrasekhara V, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc. 2015;81:81–9.CrossRefGoogle Scholar
  9. 9.
    Smiley S, Almyroudis N, Segal B. Epidemiology and management of opportunistic infections in immunocompromised patients with cancer. Abstr Hematol Oncol. 2005;8:20–30.Google Scholar
  10. 10.
    Perazzoli C, Feitosa MR, de Figueiredo-Pontes LL, da Rocha JJR, Simões BP, Féres O. Management of acute colorectal diseases in febrile neutropenic patients. J Coloproctology. 2014;34:189–92.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Virginia Tech Carilion School of Medicine, Department of Emergency MedicineRoanokeUSA

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