Oncological Emergencies Flashcards
What is neutropenic sepsis?
A life threatening side effect of chemotherapy when the neutrophil count is dangerously low and infection has developed. This is due to marrow suppression that occurs with these cytotoxic drugs.
What neutrophil count diagnosis neutropenic sepsis?
Less than 0.5 x 10^9/ L
Because they have a suppressed immune system they may not mount a normal immune response
What factors diagnosed neutropenic sepsis?
Neutrophil count less than 0.5 x 10^9/L
Temperature greater than 38 degrees
What is thought to be the most common site of organisms causing neutropenic sepsis?
GI organisms
But a source is only found in around 20-30%
What tests should you do to investigate for the cause of neutropenic sepsis?
Blood culture
Urine dip and culture
CXR
Examine the skin for any signs- e.g. Cellulitis
Check venous catheters for potential signs of infection- PIC or Hickman lines
Why should you have a low threshold for suspecting neutropenic sepsis?
They are immunosuppressed and so are unlikely to mount a standard immune response
What is the definition of neutropenic sepsis?
Neutrophil count less than 0.5
And either
- Temp greater than 38
- Any signs of symptoms of sepsis
What is the management of neutropenic sepsis?
It’s a medical emergency as mortality rates are high. Give ABx even without results if fever in chemotherapy patients. Delays in antibiotics result in worse outcomes.
Buzz-word- Say start a neutropenic regime.
Barrier nursing, ideally isolate in side room
Take blood cultures,
Bloods- check FBC, U&E, ESR, CRP, INR, LFTs, Lactate
CXR is indicated and urine culture
Broad spectrum IV ABx e.g Piperacillin and Tazobactam. Follow trust guidelines.
Check vital signs often e.g. every 2-4 hours
If fever persists after ABX think of virus (CMV) or fungal causes (PJP)
What should you say you will start if neutropenic sepsis is suspected?
Start a neutropenic regimen
What antibiotics should be given if neutropenic sepsis is suspected?
Piperacillin and Tazobactam IV recommended by NICE
But follow trust guidelines
What should you consider if there is failure to respond to ABx therapy?
Viral cause- CMV
Fungal cause- PJP
What is tumour lysis syndrome?
Oncological emergency that occurs due to the breakdown of lots of cells causing release of intracellular contents
When does tumour lysis often occur?
After chemotherapy but can happen spontaneously
What important factors are raised in tumour lysis syndrome?
Uric acid
Phosphate
Potassium
Why is uric acid/urate raised in tumour lysis syndrome?
Due to release of cell DNA which is broken down. DNA is broken down to purines and pyrimidines which are broken down into xanthines, xanthine oxidase converts xanthines into uric acid.
Why does a raised uric acid cause an AKI?
Uric acid precipitates to form crystals in the distal tubules and collecting system, obstruction the flow of filtrate in the nephron. Leads to AKI.
What are two important consequences of tumour lysis syndrome?
Raised urate can cause an AKI, can cause death
Raised potassium can cause arrhythmias, can cause death