Haematological emergencies Flashcards
List some causes of neutropenia
decreased production - ie bone marrow issue:
- acute leukaemia
- myelodysplastic syndrome
- marrow infiltration
- B12/folate deficiency
- medications eg methotrexate, carbimazole, clozapine
iatrogenic:
- chemotherapy
What are the clinical features of neutropenic sepsis?
fever
rigors
malaise
less common: low BP, cardiovascular collapse and death
When should you suspect neutropenic sepsis?
if someone has had chemo in the last 3 months presents with fever chills/rigors malaise isolated hypotension
What are the top three things you must do if you suspect neutropenic sepsis?
- see the pt immediately
- put a cannula in
- give antibiotics in sheffield this is Tazocin and gentamycin
What are the clinical features of a sickle cell crisis?
gradual onset over 2-3 days of pain
eventually the pain is unbearable and can be in their arms, hands, legs, back, ribs, chest, abdomen
pts often have a typical site of pain
What is the cause of a sickle cell crisis?
can be precipitated by dehydration, infection, stress, alcohol, cold
the RBCs deform and become sickle shaped which can leads to vaso-occlusive events eg acute chest syndrome due to occlusion of the pulmonary vasculature, splenic sequestration and shock, aplastic crises and haemolytic crises, bone crises are due to bone infarcts due to vaso-occlusion in the bone vessels
What are the worrying symptoms of sickle cell crises?
chest pain - as could be chest crises eg PE or ACS
severe abdominal pain
neurological symptoms as at high risk of stroke
What are the three main points of management when it comes to sickle cell crises?
- see the pt
- control the pain eg paracetamol, ibuprofen or morphine
- put a cannula in an d start fluids - to prevent dehydration and put them on O2 if they have low oxygen sats
What is acute chest syndrome?
the pt has a vaso-occlusive crisis in their lungs, causing infarction of the lungs and so hypoxia, which then generates more sickles and these cause further lung infarction and the cycle starts again
What are the clinical features of acute chest syndrome?
new signs on CXR
hypoxia
chest signs
eg may look like they have pneumonia but it is a chest crisis
How would you manage a pt with sickle cell crisis?
- see the pt
- give the pt O2/antibiotics
3) call a haematologist (as the pt needs a red cell exchange to remove the sickles)
What haematological emergency can be encountered with multiple myeloma pts?
spinal cord compression
What are the symptoms of spinal cord compression?
back pain neuropatic pain leg weakness/numbness saddle anaesthesia loss of sphincter control/urinary retention incontinence
What are the signs of spinal cord compression?
decreased power in the legs typically decreased reflexes decreased sensation PR exam shows decreased anal tone very large residual bladder volume >200ml
What 3 points of management should you do if you suspect that sb has spinal cord compression?
- keep them in bed
- dexamethasone 8mg twice a day
- urgent MRI
How would you treat a confirmed SCC in a myeloma pt?
radiotherapy
chemotherapy
NB: in pts without myeloma you may do surgery
Which immunoglobulin will cause hyperviscosity syndrome in smaller amounts and why?
IgM as it is a pentamer
What are some causes of hyperviscosity syndrome?
myeloma
acute leukaemia with hyperleukocytosis
Waldesnström’s macroglobulinaemia
polycythaemia vera
What are the symptoms of hyperviscosity syndrome?
haedaches
neurological
blurred vision
fatigue
mucosal bleeding
confusion/ altered mental state/ decreased glasgow coma score
SOB, hypoxia - could be due to pulmonary oedema
What would be seen on examination of a pt with hyperviscosity syndrome?
bruising epistaxis pulmonary oedema evidence of fluid overload decreased glasgow coma score confusion ataxia nystagmus papillodema peripheral oedema
What 3 steps of management would you do for a pt who has hyperviscosity syndrome?
- put in a cannula
- give them fluids
- call the haematologist
What is tumour lysis syndrome?
chemo kills cancer cells, causing them to release their intracellular components
gives an acute rise in plasma uric acid, potassium, phosphate and hypocalcaemia
this can cause acute renal failure due to crystallisation in the kidney
Which type of cancers is tumour lysis syndrome most likely to occur with?
rapidly dividing tumours eg acute leukaemia and Burkitt’s lymphoma
also people with a large tumour burden - more cells available to die
some solid tumours eg neuroblastoma
what drug can be given to control hyperuricaemia and how does it work?
rasburicase - oxidises uric acid to allantoin
