Haemotology Flashcards
Febrile neutropenia
oncological emergency
most common life-threatening complicatioon of cancer therapy
diagnosing febrile neutropenia
Fever (38+) and absolute neutrophil count below 500 cells per microlitre following chemo)
treating febrile neutropenia
- Prompt admission of broad spectrum antibiotics according to local policy (RDE - tazocin +/- gentamicin)
- Resuscitation appropriate to clinical situation
- Septic screen and hunt for source
common cause of febrile neutropenia
gram neg aerobic bacteria (E Coli, Klebsiella, Pseudomonas aerginosa)
what is tumour lysis syndrome
oncological emergency
metabolic and electrolyte abnormality that occurs after initiation of cancer treatment (or rarely spontaneously)
describe how tumour lysis syndrome occurs
1-5 days after chemo
rapid breakdown of large number of cancer cells and subsequent release of large amounts of intracellular content into the bloodstream, which overwhelms the normal homeostatic mechanisms
signs and symptoms of tumour lysis syndrome
N&V, diarrhoea, cramps, weakness, numbness, tingling, fatigue, recent ca treatment
how is tumour lysis syndrome diagnosed
creatinine, egfr - show renal impairment
U&Es - rasied phosphate, K and uric acid
(laboratory TLS - 2 or more of: hyperuricaemia, hyperphosphateaemia, hyperkalaemia, hypocalcaemia.
Clinical - one or more of: AKI, cardiac arrythmias, seizure or sudden death)
risk factors for tumour lysis syndrome
agressive disease
pre-existing renal failure
increased age
treatment of Tumour lysis syndrome
prevented with fluids and allopurinol. if high risk may use rasburicase instead of allopurinol.
if not given prophylaxic and develops - rasburicase
causes of superior vena cava obstruction
Superior vena cava is partially blocked or compressed. This could be due to blood clots, or enlarged lymph nodes in the durrounding area. Lung ca in the upper right lobes, or mediastinum can cause compression, cancer is the main cause
signs and symptoms of superior vena cava obstruction
- Facial swelling
- Dilated veins over SVC drained areas (neck and chest)
- Plethora (excess of bodily fluid, particularly blood)
- Muzzy head, headache, worse when bending forward
- Breathless
- Dizzy
- Changes to vision
Diagnosing superior vena cava obstruction
CT usually
Xray may show enlarged mediastinum
US to look for blood clots
risk factors for superior vena cava obstruction
LN mets NSC lung cancer Lymphoma Mets Infections Thyroid goitre Iatrogenic intravascular devises (pace maker)
treatment for superior vena cava obstruction
Anticoagulation
Underlying condition - chemo or radiotherapy
Corticosteroids to reduce swelling
Diuretics to remove fluid and increase urination
which cancers are most likely to spread to the bone
lung, breast, prostate, kidney (thyroid?)
red flags for spinal cord compression
back pain with Ascending sensory loss, sphincter dysfunction, saddle anaesthesia
treatment of spinal cord compression
MRI
steroids, chemo, surgery
which ca is most likely to cause hypercalcaemia
myeloma
signs of hypercalcaemia
Stone, bones, abdominal groans and psychic moans
Treatment of myeloma caused hypercalcaemia
Fluids, bisphosphonates and myeloma combination therapy (currently steroids +/- thalidomide +/- cytotoxic agent cyclophosphamide)
where does erythropoesis take place
fetus - liver and spleen
increasing in fetus and after birth - bone marrow (LN, spleen and liver in times of infection)
where does the breakdown of RBC take place
liver
Bone marrow
spleen
