Supportive care facts Flashcards
TLS criteria
2 of:
Uric acid > 8
Ca < 7
K >6
P > 4.5
+ 1 Clinical:
AKI
Arrythmia
Seizure
Death
Maintaining urine output in TLS
Fluids to 2ml/kg/h
add fusid if urine output not met
Rasburicase indication in TLS
Moderate- High tumor burden with high lysis potential
Laboratory TLS
Allopurinol indication in TLS prevention
Medium tumor burden +
Preexisting nephropathy/
Dehydration/
Acidosis/
Hypotension/
Nephrotoxin exposure/
EPO in cancer related anemia
Aim of Hb of 10 g%
Treat in non-curative cancers
Tx of SVC syndrome
If diagnosis is certain Tx with steroids
If not certain diagnosis is lymphoma endovascular stent or endovascular thrmobolysis (If thrombus present) may be needed
Tx of leukostasis
Induction Tx
If not possible immediately - HU or PEX
GCSF indication in CHOP Tx pts
Age > 65
Prior cytopenia
High ECOG
Severe comorbidities
Tx of hypervisosity in MM
PEX
Tx of leukostasis in AML
Hydrea
Chemo
PEX if chemo not possible immediately
Tx of AKI in MM
Fluids
Vd
Dialysis
Correct Ca
Tx of cord dompression in MM
RT (8 Gy once, or 20 Gy in 5-10 fractions)
Dexa
Surgery if emergancy
Tx of differentiation syndrome
IV dexa 10 mg bid
Management of fluid over load, AKI, fever
Clinical manifestations of differentiation syndrome
Fever, hypotension, ansarca, AKI
Emergencies in leukemia
Disease burden- Leukostasis, TLS
Cytoenias- Infection, bleeding, HF
DIC
Emergencies in MM
CRAB- Cord compression/ Pathological Fractures, AKI, hypercalcemia, severe anemia
Other- Infection, Hypervisocity
Emergencies in lymphoma
Metabloic/systemic:
TLS
Hypercalcemia
Hyperviscosity
Infection
Structural emergencies:
SVC syndrome
Pericardial/pleural effusion
Cord compression
Organ compromise
Emergencies in benign hematology
MAHA
Acute chess syndrome
Severe hemolysis
Bleeding with cougulation defect
CAPS
DIC
Emergencies presenting with pancytopenia
Leukemia
AA
DIC
HLH
Causes of pancytopenia
Nutritional disorders
Infections
AI
Carcinoma
MPN/MDS/AML/ALL/LY+-HLH/AA
Cirrhosis?
