Hematology oncology emergencies Flashcards
What is the most common oncologic emergency
Neutropenic fever
A life-threatening condition, tissues become damaged and BP drops becuase bacteria are multiplying and producing poisins in the blood
leads to septic shock
Septic shock risk factors
Additional immunosuppression
Implanted divices (port line)
Chronic conditions/elderly
Typhlitis definition and risk factors
Bacterial invasion of cecum, leads to necrotizing colitis
Risk is mucositis, diverticulitis, stem cell transplant
DIC definition
Use more coagulation factors than you make
Your patient has decreased platlets, decreased prothrombin, PTT, and fibrinogen. What are you concnerned about
DIC–Use more coagulation factors than you make, so body has bleeding and ischemia
DIC clinical presentation
Petechiae, echymosis
Tumor lysis syndrome definition and who is at risk
Metabolic abnormalities, result from rapid breakdown of malignant cells
High risk leukemias (ALL, AML)
Lymphoma patients (burkitts)
Presentation of Tumor Lysis syndrome
PUCK
P- hyperphosphatemia
U- Hyperuricemia
C- Hypocalcemia
K- Hyperkalemia
Also Tachycardia(cardio), Respiratory: respiratory distress, Abdominal/Renal: Back and flank pain, Muscle changes, Electrolyte changes, Seizures because of neuro changes
Tumor lysis syndrome management
Hydrate hydrate hydrate– 2-3x maintenance fluids
Hyperleukocytosis and leukostasis
Hyperleukocytosis is high WBC count, Leukostasis is when you have symptoms
Peripheral WBCs are really really high
Clog up vasculature, cause ischemia
Fever/pain
Spinal cord compression risk factors
Metastatic disease to spine that is in canal, or lymphoma if in bone, neuroblastoma
Presentation of spinal cord compression
Localized or radicular pain, motor deficits, sensory deficits (bowel/bladder dysfunction, loss of sensation)
Spinal cord compression management
Neuro exam
MRI of spine
Glucocorticoids
Treat underlying disease
SVC syndrome Definition and risk factor
Compression of Superior Vena Cava (SVC)
Can also be tracheal compression
Vascular compression upstream of compression (head and neck and face)
Risk factors:
Lymphomas
Hodgkin’s/Non hodgkin’s
Germ cell tumor
ALL
Sarcomas
SVC syndrome presentation
Dyspnea, cough, orthopenia, engorged vessels
SVC syndrome management
Treat underlying cause with radiation or ressection
SIADH risk factor drugs
Chemotherapy drugs:
Vincristine
Cyclophosphamide
Ifosfamide
Decreased urine output–> hyponeutremia
Immune related adverse events of ICIs Symptoms and treatments
Immunotherapy checkpoint inhibitors dysfunctioning
Symptoms: Rash, diarrhea, liver elevation, myocarditis
Treat by stopping immunotherapy and giving steroids
SIADH disease pathology
Inrease of ADH leads to low sodium, water retnetion, causes cerebral edema, coma, death.
Na<120 mEq/L.
SIADH management
Treat underlying cause
Diuretics
Steroids
Untreated SIADH can lead to neuro deficits from cerebral edema
What is the focus of treatment for Tumor Lysis syndrome
Facilitate renal excretion of metabolites by hyperhydration
Overall treatment goal for DIC
Treat underlying cause of DIC
