Malignant haematological emergencies Flashcards
What is time frame for antibiotics in neutropenic spesis
60 minutes
When to act on neutropenic spesis eg antibiotics
one measure >38.5
Two measuers hour apart >38
Neutropenia level
<0.5 x10
Assessment neutropenic sepsis
BP, clammy, urine outout
Bloods esp cultures
CXR
Management neutropenic spesis
Call for help
Antibiotics within 60 mins
ITU - contact early
Hypercalcemia level
> 2.6
3.4 is severe
Symptoms of hypercalcaemia
Pancreatitis, fatigue, onstipation, wekaness, polyruia, kdiney stones, N+V, peptic ulcers, confusion, coma
-Mechanisms of hypercalcemia
PTH realted peptide
Lytic bone lesions
1,25 hydroxy vut D increased production by tumours
Treatment hypercalcemia
Isotonic saline
Bisphosphonates - poamidronate or zolendronate - 1-2 days to work
Calcitonin - only if life threat
Steroids
Risky tumours for tumour lysis syndrome
non hodhkin lymphoma
Bulky lymphoid tumours
Prevention tumour lysis syndrome
Allopurinol, rasburicase
Aggressive hydration
Renal tema, ITU
Spinal cord compression features
Back pain
Doesnt go away with pain killers, Prevents sleep, Worse by straining or moving
Sharp band of pain around body
Sudden weakness arms and legs
Loss feeling arms or legs, bladder or bowel problems
Most likely causes spinal cord compression
Lymphoma, myeloma
Management for spinal cord compression
Pain releif
Imaging - MRI whole body
Steroids - HIGH DOSE DEXAMTHASONE
Radiotherapy
?surgery
Ring haem/onc, radiotherapy, neurosurgery
What is HLH
Haemophagocyticlymphhistiocytosis
Severe hyperinflammation
Uncontrolled activation of immune system
Cytokines +++, activated lymphocytes and amcrophage
