Oncologic Emergencies

Question 1

Hyperleukocytosis
Definition
Complications — 6
Management — 1

Answer 1

WBC > 50k
WBC >100k is leukemia until proven otherwise

Complications
— leukostasis from “sticky” large blasts > increased viscosity > tissue hypoxia
> neuro issues: headache, dizzy, intracranial hemorrhage
> respiratory: SOB, hypoxia, infiltrates on CXR
> worsened by PRBC transfusion
> tumour lysis syndrome
> DIC

Management
— cytoreduction > leukapheresis, chemo, hydroxyurea

Question 2

Tumour Lysis Syndrome
Definition and impact
Risk factors: 2 main ones
Symptoms 4
Complications 4
Management 3

Answer 2

See image

Allopurinol/Rasburicase are used to lower levels of uric acid in your blood

Question 3

Spinal cord compression
What is it most likely due to? 2
Symptoms?
Work up?
Management?

Answer 3

Steroids, debulking and radiation

Question 4

Mediastinal mass
How is it discovered?
What is the effect?
Risk factors?
Symptoms?
Work up
Management

Answer 4

See image
Priority here is airway and heart!

Question 5

SVC Syndrome
Caused by? (3)
Risk factors (2)
Symptoms ~4
Management ~4

Answer 5

See image

Question 6

Febrile Neutropenia
Causes
What constitutes a medical emergency?
What are these patients at risk of?
Which may be the only sign?
What treatment do they need ASAP?
Where do you look for sources of infection?

Answer 6

ANC < 500 and fever of 38 degrees C twice in one hour

These patients need broad spectrum ABX within an hour of arriving at the ED