haematology: clinical emergency Flashcards
(28 cards)
What is leukostasis
Symptomatic hyperviscosity due to high WBC count in patient with leukaemia
What is some examples of leukostasis clinical presentation
Pulmonary: dyspnea & hypoxia
Cerebral: headache, dizziness, blurred vision, infarcts
Fever
Rare: CCF
What is the work up for leukostasis
FBC for WBC that is elevated
Imaging to identify the cause
What is the five management steps for leukostasis
- Intensive chemotherapy
- Leukapheresis
- Hydroxyurea
- Supportive & preventative therapy for metabolic abnormalities & tumour lysis syndrome
- Transfuse RBC carefully
What is neutropenic sepsis diagnostic criteria
Temperature >38.3C/2 x 37.8C & neutrophil count <0.5 x109/L
What factors increases risk for neutropenic sepsis
Increased risk for infections due to mucosal barriers breakdown, indwelling catheter & immunosuppressive agents
Life threatening that can lead to septic chock & death
What is the work up for neutropenic sepsis
Cultures
Imaging: CXR
Viral infections testing
What is the two management steps for neutropenic sepsis
Broad spectrum antibiotic
Prevention: isolation, strict handwashing, limiting visitors, air filtration, prophylactic antibiotics
What is spinal cord compression
Complication of haematological neoplasms
What is some examples of spinal cord compression clinical presentation
Back pain, mechanical instability of spine & potentially irreversible loss of neurological function
What is the work up for spinal cord compression
Spinal X-ray & MRI to identify compression
Tissue for histological diagnosis
What is the five management steps for spinal cord compression
- Diagnose & treat within 24 hrs
- Laminectomy & decompression
- Radiotherapy/chemotherapy
- High dose corticosteroids
- Rehabilitation
What is acute promyelocytic leukaemia
AML subtype but aggressive disease with high mortality & specific effective treatment (good outcomes)
What is some examples of acute promyelocytic leukaemia clinical presentation
Bleeding, bruising, DIC bleeding
What is the work up for acute promyelocytic leukaemia
FBC, differential count, blood film: abnormal promyelocytes
DIC screen: prolonged PT & PTT, low fibrinogen, low PLT count & high D-dimer
Genetic hallmark: t(15;17)
What is the four management steps for acute promyelocytic leukaemia
- Hospitalised with emergency treatment (ATRA)
- Differentiation syndrome prophylaxis: corticosteroids
- Coagulopathy support & replacement of fibrinogen & platelets
- Avoid invasive procedure
What syndrome is seen in acute promyelocytic leukaemia
Distinct haemorrhagic syndrome: primary hyperfibrinolysis & consumptive coagulopathy
What is differentiation syndrome
Release of cytokines increase inflammation, vascular permeability & endothelial dysfunction
What is tumour lysis syndrome
Haemato-metabolic syndrome that lysis of large number of malignant cells/blasts releasing nucleic acids, potassium & phosphate
What cancer are associated with tumour lysis syndrome
ALL, high grade lymphoma (Burkitt lymphoma) & acute leukaemia with severe leukocytosis
What does the severity of tumour lysis syndrome depend on
- Release of pathogenic molecules
- Patient’s ability to compensate for physiological changes
What is superior vena cava syndrome
Obstruction of blood flow through the SVC (benign or malignant)
What is the causes of superior vena cava syndrome
Malignancy direct invasion of tumour into SVC/external compression of SVC by adjacent pathological process
What is some examples of superior vena cava syndrome clinical presentation
Oedema of head, neck & arms, distended neck veins, chest pain, cough, stridor, dysphagia
