Haematological Emergencies Flashcards
Febrile neutropenia
Who is at risk? (4)
- Chemo > 6 weeks ago
- Stem cell transplant/high dose chemo < 1 year
- Aplastic anaemia/leukaemia/autoimmune disease
- People on METHOTREXATE, CARBIMAZOLE, CLOZAPINE
Febrile neutropenia
Clinical presentation
Temp > 38 degrees Celsius
Absolute neutrophil count < 1X10/L
- Malaise
- Sweats / rigors
- Cough / sore throat
- Abdo pain
- Diarrhoea
- Pain around central venous catheter
- Tachycardia
- Hypotension
- Raised resp rate
Febrile neutropenia
Management
- Start broad-spec antibiotics (IV) within 1hr of admission
- Do NOT catheterise (increased infection risk)
Malignant spinal cord compression
Who is at risk?
- Bone mets and vertebral collapse
- Local tumour extension
- Deposition of malignant cells within cord
- Commonly seen in MYELOMA and LYMPHOMA
Malignant spinal cord compression
Clinical presentation
- Back pain
- Weakness/numbness in legs
- Inability to control bladder/bowel
- Saddle parasthaesia
- Decreased perianal sensation and anal tone
Malignant spinal cord compression
Management
- TIME = NERVES
- Strict bed rest
- High dose steroid, e.g. ORAL DEXAMETHASONE
- Analgesia
- Urgent MRI of whole spine
Tumour Lysis Syndrome
Define
Life-threatening metabolic derangement that occurs when malignant cells BREAKDOWN -> resulting in neuro, cardio and renal complications.
Tumour Lysis Syndrome
Clinical presentation
- High uric acid
- Hyperkalaemia
- Hyperphosphataemia
- Hypocalcaemia
Tumour Lysis Syndrome
Who is at risk?
- High tumour burden
- High grade disease (rapid cell turnover)
- Pre-existing renal impairment
- Increasing age
- Drugs that increase uric acid formation (e.g. alcohol)
Tumour Lysis Syndrome
Management
- Aggressive hydration
- ALLOPURINOL or RASBURICASE (reduce uric acid production)
- Monitor electrolytes
- Refer for dialysis if needed
Hyperviscosity Syndrome
Define
Increase in blood viscosity, usually due to high immunoglobulins
Hyperviscosity Syndrome
Seen in?
Myeloma and Waldenstrom macroglobulinaemia
Or increased cell numbers -> Leukaemia/Polycythaemia
Hyperviscosity Syndrome
Result in?
Vascular stasis
Hypo-perfusion
Hyperviscosity Syndrome
Clinical presentation
- Mucosal bleeding
- Visual changes
- Neuro changes
- SOB
- Fatigue/anorexia
- Bruising/bleeding gums
- Ataxia/nyastagmus
Hyperviscosity Syndrome
Diagnosis
- Plasma viscosity level
- CT head - to exclude other signs
- Immunoglobulin levels
- FBC
