Haematology Suppportive Care

Question 1

Risks for haematology patients

Answer 1

Infection, prophylaxis, access, transfusion,chemo, renal failure, tumour lysis syndrome, fertility, neutropenia sepsis

Question 2

Neutropenia sepsis

Answer 2

Neutropenia or recent chemo
Tazocin
Cultures from peripheral veins and indwelling lines
Inspect entry sites, remove if infected
Consider atypical- fungal if not responding to abx

Question 3

Preventing infection

Answer 3

Aciclovir- against varicella and herpes reactivation
Posaconazole- prevent fungal
Co-trimoxazole- prevent PCP pneumonia

Question 4

G-CSF
Granulocyte colony stimulating factor

Answer 4

◦ Can reduce severity & duration of neutropenia
◦ Sub-cutaneous injection
◦ Side effects – bone pain, headache, fatigue & nausea
◦ Often used prophylactically in lymphoma regimes
where period of neutropenia is expected

Question 5

FFP

Answer 5

1215ml/kg
Used to replace
clotting factors to
prevent/treat bleeding

Question 6

Cryoprecipitate

Answer 6

2 pooled doses
Used to replace
fibrinogen
Most commonly in major haemorrhage or
congenital low fibrinogen states

Question 7

Tumour lysis syndrome

Answer 7

 Tumour cell lysis releases various cellular components into the circulation causing metabolic derangements.
 Classified as laboratory and clinical.
Lab: high Uric acid, high potassium, high phosphorous, low calcium
Clinical:high creatinine, arrhythmia/sudden death, seizure
Allopurinol- inhibits UA production
Rasburicase- clears UA

Question 8

Mucositis

Answer 8

 Mouthwashes- chlorhexidine, Difflam
 Significant diarrhoea and fluid losses can be
challenging  Third spacing due to fluid leakage and loss of
protein