Infections in Haematological Malignancy

Question 1

What supportive measures can be given to reduce risk of sepsis in haematological malignancy?

Answer 1

Prophylaxis (antimicrobials)
Growth factors e.g. G-CSF
Stem cell rescue/transplant
Protective environment e.g. laminar flow rooms
Intravenous immunoglobulin replacement
Vaccination

Question 2

How does neutropenic sepsis present?

Answer 2

Fever with no localising signs (Single reading of >38.50C or 380C on two readings one hour apart)
Rigors
Chest infection/ pneumonia
Skin sepsis - cellulitis
Urinary tract infection
Septic shock

Question 3

What investigations can be used in neutropenic sepsis?

Answer 3

History and examination
Blood cultures -Hickman line & peripheral
CXR
Throat swab & other clinical sites of infection
Sputum if productive
FBC, renal and liver function, coagulation screen

Question 4

Why can patients become lymphopenic?

Answer 4

Stem cell transplant recipients, especially allogeneic
Recipients of Total Body Irradiation (TBI)
Graft vs Host Disease
Nucleoside analogues (fludarabine) or ATG
Lymphoid malignancy e.g Lymphoma, CLL, ALL