Myelosuppression

Question 1

Causes of myelosuppression

Answer 1

Chemo
Biological therapies eg interferon + interleukin-2
Bone marrow infiltration
Paraneoplastic syndromes

Question 2

How does bone marrow infiltration manifest?

Answer 2

Produces pancytopenia

Common in haematological cancers, breast, lung + prostate cancer

Question 3

What type of anaemia do you get from chemo?

Answer 3

Macrocytic not megaloblastic

Question 4

How do you investigate myelosuppression?

Answer 4

Blood film, measure haematinics, bone marrow aspirate + trephine

Question 5

Treatment of thrombocytopenia

Answer 5

Regular platelet infusions - need for single donor or HLA matched platelets

Question 6

Signs of clinical thrombocytopenia

Answer 6

Petechial haemorrhage, spontaneous nosebleeds, corneal haemorrhage, haematuria

Question 7

When does neutropenia become a reason for admission?

Answer 7

Total white count <1x10 with fever = immediate inpatient admission + broad spectrum abx

Question 8

Investigations for neutropenic sepsis

Answer 8

Physical exam (not vaginal or rectal)
Blood cultures
Cultures of urine, sputum + throat
CXR

Question 9

When are prophylactic abx used?

Answer 9

Use of co-trimoxazole in pts with lymphoma at risk of PCP