myelosuprression

Question 1

aetiology of myelosuppression in cancer

Answer 1

Question 2

investigations of myelosuppression

Answer 2

A transient nadir in blood counts following chemotherapy can be observed. However, prolonged or excessive degrees of suppression require investigation to exclude alternative causes such as marrow infiltration.
Full evaluation includes a blood film, measurement of haematinics, bone marrow aspirate and trephine.

Question 3

anemia treatment in cancer patients

Answer 3

A haemoglobin level less than 10 g/dl may well impair quality of life and patients can potentially benefit from blood transfusion. The use of recombinant erythropoetin in preventing symptomatic anaemia can also be beneficial, and reduce risks of transfusion reactions and viral transmission.

Question 4

Clinical signs of significant thrombocytopenia include

Answer 4

petechial haemorrhage, spontaneous nose bleeds, corneal haemorrhage and haematuria

Question 5

the link between chemotherapy and thrombocytopaenia

Answer 5

. Conventional doses of chemotherapy rarely cause clinically important thrombocytopenia. The use of high dose chemotherapy is associated with prolonged thrombocytopenia requiring regular platelet transfusions

Question 6

at which platelet count level do you start treating patients with transfusions?

Answer 6

• Platelet counts less than 10 x 109/L are associated with a significant risk of spontaneous bleeding such as intra cerebral haemorrhage, with a risk of irreversible disability. They are an urgent indication for platelet transfusion.
• Platelet counts between 10 x 109/L and 20 x 109/L are frequently supported with platelet transfusion, particularly in the presence of other complications such as infection.
• Platelet counts greater than 20 x 109/L, in the absence of spontaneous bleeding, do not routinely require platelet transfusion.

Question 7

Repeated administration of blood products such as platelets is associated with the risk of?

Answer 7

• development of specific antibodies to blood cells including platelets.
• This manifests as a failure to increase platelet counts immediately after transfusion.
• This suggests the need for single donor (rather than pooled) or HLA matched platelets.

Question 8

the most frequent cause of morbidity and mortality associated with myelosuppression.

Answer 8

Neutropenic infection is an emergency, requiring urgent broad-spectrum intravenous antibiotics.

Question 9

neutropenia presentation

Answer 9

• Any patient who becomes pyrexial following cytotoxic chemotherapy requires immediate review (within the hour) to assess the degree of neutropenia. Total white counts less than 1 x 109/L with an associated fever require immediate in-patient management with broad spectrum antibiotics.
• Neutropenic patients may not have a raised temperature despite overwhelming sepsis but present feeling non¬-specifically unwell.
• Severe infection with end-organ failure, such as renal or respiratory compromise will be supported with growth factors and admission to intensive care where appropriate.

Question 10

neutropenia investigations

Answer 10

• Careful physical examination to look for potential sites of infection is indicated
• but rectal and vaginal examinations should not be done because of the risk of causing bacteraemia if the mucosa is breached.
• Extensive cultures of blood, urine, sputum, throat etc. and a chest X-ray are taken, and may influence subsequent changes to antibiotic therapy

Question 11

neutropenia management

Answer 11

• broad spectrum antibiotics
• if failure to respond in 48 hours switch to second line broad spectrum
• Persistent fever despite appropriate antibiotic treatment requires consideration of additional antifungal or antiviral agents as atypical agents can happen

Question 12

prevention of myelosuppression

Answer 12