Haematological Supportive Therapy

Question 1

Transfusion

• RBC dose and effect
• Platelets dose and effect

Answer 1

Transfusion

• RBC
  1. 1 unit
  2. 10g/L rise in 70gk male
• Platelets
  1. 1 adult dose (10^11)

Question 2

Transfusion Requirements
- CMV neg

Answer 2

CMV Negative Transfusions

1. Neonates
2. Intrauterine
3. Pregnancy (elective transfusion)

Question 3

Transfusion requirements
- Irradiated blood

Answer 3

Irradiated blood transfusions

1. BMT/SCT
2. Stem cell harvest
   - preceding 7 days
3. Hodkin’s disease
4. Drugs
   - Purine analogues
   - Alemtuzumab
5. HLA matched products
6. Congenital T cell immunodeficiency
7. Intrauterine transfusion

Question 4

Tunnelled central lines
- Process (setting/practitioner)
- Incisions

Answer 4

Tunnelled central lines

• Process
  1. GA/Sedation
  2. Surgeon/radiologist
• Incisions
  1. Jugular Vein
• Into SVC
  2. 2nd site
• Tunnelling to skin

Question 5

Tumour Lysis Syndrome

• Laboratory markers

Answer 5

Laboratory Tumour Lysis Syndrome

1. Uric acid (25% INcrease)
   >476 micromol/L
2. K (25% INcrease)
   >6.0 mmol/L
3. P (25% INcrease)
   >1.45 mmol/L (adult)
4. Ca (25% DEcrease)
   <1.75 mmol/L

Question 6

Tumour Lysis Syndrome
- Cairo-Bishop clinical definition

Answer 6

Clinical Tumour Lysis Syndrome

1. Creatinine
   >1.5 ULN
2. Cardiac arrhythmia/sudden death
3. Seizure

Question 7

Tumour Lysis Syndrome

• Mortality
• Prevention

Answer 7

Tumour Lysis Syndrome

• Mortality
  1. 15%
  2. Any patient with haematological malignancy
• Prevention
  1. Allopurinol
• Inhibits xanthine oxidase

2. Rasburicase
   - Urate oxidase

Question 8

Haematological infections

• Prevention
  1. Mouth
  2. Fungal
  3. Viral
  4. Bacterial

Answer 8

Infection prevention - haematology

1. Mouth care
   - Chlorhexidine qds

• Fungal
  1. Fluconazole/isavuconazole/posaconazole
  2. PCP
• Co-trimoxazole
• Viral
  1. Aciclovir
• Bacterial
  1. ABx

Question 9

Haematological malignancies
- Contraception

1. DOs
2. Don’ts

Answer 9

Contraception - haem malignancies

• DOs
  1. Norethisterone (acute leukaemia)
  2. Barrier protection

Dont’s
1. COCP if high thrombotic risk

Question 10

Neutropenic sepsis

• Definition

Answer 10

Neutropenic sepsis

1. > 38.0
2. > 37.5 for 1 hour
3. Neutrophils
   <0.5
   <1.0 and falling

Question 11

Neutropenic sepsis

1. Standard tx
2. Penicillin allergic
3. Septic shock
4. Line infection/severe mucositis

Answer 11

Neutropenic sepsis

1. Standard
   - Tazocin 4.5g tds
2. Penicillin allergic
   - Meropenem
3. Septic shock
   - Gentamicin (aminoglycoside)
   - 7mg/kg
4. Line infection/severe mucositis
   - Vancomycin/teicoplanin/linezolid