Complications of Haematologic Malignancies

Question 1

What is hyper viscosity syndrome?

Answer 1

Refers to clinical sequelae of increased blood viscosity resulting from increased serum Igs or increased cellular blood components in hyper proliferative disorders (e.g. MM, leukaemia, PV)

Question 2

What accounts for 85% of cases of hyper viscosity syndrome?

Answer 2

Waldenstrom’s macroglobulinemia

Question 3

What are the CFx of hyper viscosity syndrome

Answer 3

• Hypervolemia: CHF, headache, lethargy, dilutional anaemia
• CNS Sx due to decreased cerebral blood flow (headache, vertigo, stroke)
• Retina: venous engorgement and haemorrhages
• Bleeding diathesis (impaired platelet function, absorption of soluble coagulation factors)
• ESR usually very low

Question 4

Treatment of hyper viscosity syndrome?

Answer 4

Plasmapharesis, chemotherapy

Question 5

What is tumour lysis syndrome?

Answer 5

Group of metabolic complications resulting from spontaneous or treatment related breakdown of cancer cells

Question 6

When is tumour lysis syndrome more common?

Answer 6

Disease with large tumour burden and high proliferative rate (high grade lymphoma, leukemias)

Question 7

What are the CFx of tumour lysis syndrome?

Answer 7

• metabolic abnormalities (cells lyse, releasing K+, uric acid, PO4^3-)
• Phosphate binds Ca2+ ==> decreased Ca2+

Question 8

What are the complications of tumour lysis syndrome?

Answer 8

• Lethal cardiac arrhythmias (increased K+)

- Acute renal failure (urate nephropathy)

Question 9

Prevention of tumour lysis syndrome?

Answer 9

-Aggressive IV hydration
-Alkalinisation of the urine
-Allopurinol
-Correction of pre existing metabolic abnormalities
Rx = dialysis