Oncologic emergencies Flashcards
define febrile neutropenia
fever >38 for >1h
Absolute neutrophil count <1500 cells/uL
how to calculate absolute neutrophil count
WBC x (%neutrophils + %bands)
how can chemo cause febrile neutropenia?
chemo ➔ decreases the immune system ➔ nadir ~1wk after chemo ➔ easier to be infected ➔ fever + low neutrophil counts
ix for febrile neutropenia
CBC
find the source – blood cultures x2 + swab anything + urines + stool
imaging for pneumonia etc.
tx febrile neutropenia
empiric abx - piptazo, vanco, metronidazole
admit
consult ID and onc
granulocyte colony stimulating factor
key s/s of spinal cord compression
progressive back pain not alleviated by anything + bowel or urinary dysfunction
saddle anesthesia, paresthesias etc
ix for spinal cord compression
MRI
common cancers that cause spinal cord compression
lung
multiple myeloma
prostate
tx for spinal cord compression
steroids - dexamethasone +/- PPI w/high dose
consult surgery and radiation – require decompression
pain management - opioids or NSAIDS
define leukostasis
increase in immature leukocytes in the blood resulting in decrease blood flow because of aggregate formation and increase of blood viscosity
cancer most common to have leukostasis
leukemias and lymphomas
s/s of leukostasis
vision changes
ALoC and headaches
SOB
tx leukostasis
leukopheresis
fluids
hydroxyurea
tx for potential tumour lysis syndrome: allopurinol
define hyperviscosity syndrome
increase blood viscosity because of an increase in serum proteins
which cancer most common to have hyperviscosity syndrome
MM - Waldenstrom’s
s/s of hyperviscosity syndrome?
vision changes, headache, mucosal bleeding
tx of hyperviscosity syndrome
phlebotomy
fluids
plasmapheresis
difference between hyperviscosity syndrome and leukostasis
leukostasis results in wbc aggregates blocking the blood fluid whist also increasing blood viscosity
hypervisosity syndrome - blood cells and proteins reuslting int he thickening of the blood
define tumour lysis syndrome
increase in phosphate, potassium, and uric acid and a decrease in Ca
when there is an overwhelming about of cellular contents released that the kidney is unable to clear it
s/s of tumour lysis syndrome
arrythmias, palpitations
gout s/s - joint pain
N/V cramps, fatigue
cancers most common to have tumour lysis syndrome as cx
leukemia bc of induction therapy
ix for suspected tumour lysis syndrome
blood work
extended lytes
uric acid
lytes
tx for tumour lysis syndrome
fluids
allopurinol
insulin and dex for potassium
