Heme/Onc Emergencies Flashcards
Effect of steroids for acute chest crisis?
Reuce deteroriation & transfucion requirement, but increase recurrence rate.
Role for hydroxyurea in acute chest crisis?
None, only in chronic disease
Treatment of acute chest crisis?
Abx targeting encapsulated organisms & atypicals. Simple / exchange transfusions.
Classic findings of AML?
Gingival hyperplasia, rash, LAD
Classic findings of APL?
Bleeding, thrombosis (DIC, fibrinolysis). Auer rods.
Classic findings of ALL?
LAD, organomegaly, CNS dysfunction, bone pain, tumor lysis
Classic findings of T Cell Leukemia?
Hypercalcemia, bone lesions
Age incidence of APL?
Teens - 60s.
Translocation of APL?
t(15;17)
Treatment of APL?
ATRA (all-trans-retinoic-acid). Diffferentiates promyelocytes to neutrophils.
2nd line is Arsenic Trioxide. Preferred if WBC < 10k.
What is Differention Syndrome?
side effect of ATRA treatment for APL? Cytokine release, increase APL adhesion via beta-2 integrins. Fever, leukocytosis, pulm infiltrates, effusion. Looks like HF, PNA, Sepsis.
Treatment of differention Syndrome?
Dexamethasone.
Treatment of hyperleukocytosis in AML?
Leukapharesis. Cyrotreduction w/ chemo preferred if not emergent. Cranial irridiation.
Symptoms of hypercalcemia?
Lethargy, confusion, constipation, hypovoleumia, bradyarrhythmias
Treatment of hypercalcemia?
- IVF, loop diuretics.
- HD if Ca > 18, HF, severe AKI, AMS.
- Bisphosphnates (zolendronic acid, pamidronate)
- Steroids
- Calcitonin (tachyphylaxis)
Indications for HD in hypercalcemia?
Ca < 18, severe AKI, AMS.
Most Common cancers to met to bone?
Lung, breast, prostate.
Consider MM, NHL, RCC.
Indication for steroids for bony mets?
focal neuro changes due to spine mets
Pathophysiology of hyperviscoscity syndrome?
Elevated IgG. Can be due to aggressive IVIG treatment.
Classic triad of hyperviscosity syndrome?
Mucosal bleeds, neuro changes, vision changes.
Rouleaux formation on peripheral blood smear indicative of what?
Hyperviscosity syndrome
Treatment of hyperviscosity syndrome?
Plasmapharesis, chemotherapy
Classic underlying cancers causing tumor lysis syndrome when treated? (5)
Burkitt’s lymphoma, NHL, ALL, DLBCL, AML
Treatment of tumor lysis syndrome?
Rasburicase. HD possibly, for normal indications.
Prophylaxis for tumor lysis syndrome?
Allopurinol. Febuxostat is 2nd line.
Contraindication to giving rasburicase?
G6PD-Deficiency.
MCC of SVC syndrome? 3 others?
MCC is NSCLC (50%). Others are SCC, lymphoma, mets.
MCC of mets to CNS?
melanoma, lung, breast.
Size of brain met which indicates neurosurgery?
> 4-5cm
