Supportive care in haematological cancers Flashcards
1 unit of red blood cells
Increases Hb by 10g/L
1 unit of platelets
10^11 platelets
When are irradiated products used
- In bone marrow or stem cell transplant patients
- 7 days before stem cell harvest
- Hodgkin’s disease
- Congenital T cell immunodeficiency
- HLA matched products
- Intrauterine tranfusion
Why are irradiated blood tranfusions given?
Decreased risk of transfusion-associated graft vs host disease
What is irradiated blood products
T cells removed
When is CMV negative blood used?
Neonates < 28 days old
Intra uterine tranfusion
Pregnancy
Different types of IV access
Cannulas
Tunnelled central line
PICC line
Portacath
Portacath
Port under skin so less likely to be pulled out.
Used in children
Tunnelled central line
Line inserted under sedation of general anaesthetic
USS or Xray guided
2 incisions - jugular vein and chest wall
- Long lasting
- Rapid IV access
Tumour lysis syndrome pathophysiology
Chemotherapy can cause rapid tumour cell lysis which releases cellular components such as K+, this causes metabolic derangements
Classes of tumour lysis syndrome
Laboratory - asymptomatic but +ve bloods
Clinical - symptomatic such as AKI, arrhythmia, seizures
Cellular components released by tumour cell lysis
Uric acid increased - gout
Potassium increased - hyperkalaemia
Phosphorous increased - hyperphosphataemia
Calcium decreased - hypocalcaemia
Symptoms of tumour lysis syndrome
AKI - creatinine > 1.5
Cardiac arrhythmia/ sudden death
Seizures
Investigations for tumour lysis syndrome
Bloods and haematinics
U+Es
ECG
Treatment of tumour lysis syndrome
Risk adaptive approach:
- Allopurinol - inhibits xanthine oxidase blocking uric acid production
- Rasburicase - urate oxidase inhibitor
Not given together
Given with chemotherapy to prevent tumour lysis syndrome
How to prevent infections
Mouth care - chlorhexidine mouthwash qds
Prophylactic antifungals - fluconazole to prevent thrush
Prophylactic co - trimoxazole - prevents pneumocystis jiroveci
Prophylactic antiviral - aciclovir - prevents the reactivation of shingles
Prophylactic antibiotics - gram negative cover
Contraception with chemotherapy
- Avoid pregnancy whilst on chemotherapy for men and women
- Requires a 3 month washout period
- Norethisterone - patients with acute leukaemia, stops menstruation
- Avoid COCP due to thrombotic risk
- Barrier protection at all times
Fertility with chemotherapy
- risk of infertility
- fertility preservation - egg collection or sperm storage
- liaise with local assisted conception unit
Neutropenic sepsis features
Fever > 38C or > 37.5 over 1 hour
Neutropenia < 0.5 or < 1 and falling
Caution - can have infection without fever
Management of neutropenic sepsis
Hospital neutropenic sepsis protocol
- Tazocin or meropenem if allergic
- Aminoglycosides - if hypotension or septic shock
(reduce gentamicin dose if low eGFR or elderly) - Vancomycin - gram +ve cover for line infections
- G-CSF subcut injection- stimulates the production of white cells, reducing the severity and duration of neutropenia
Side effects of G- CSF
Bone pain
Headaches
Fatigue
Nausea
G-CSF and leukaemia
Wait until tested to be in remission for leukaemia before giving G-CSF as can skew results
Treatment for bleeding
Tranexamic acid
Prothrombin complex concentrate - minimises effects of DOACs
Stop DOACs
Which DOAC can be reversed
Dabigatran using idarucizumab (Praxbind)
History for neutropenic sepsis
Date of last chemo and which agent
Infection symptoms
Ask about lines
Drugs and allergies
Investigations for neutropenic sepsis
Bloods - FBC, U+E, LFT, CRP, glucose and lactate
Blood culture
CXR - if symptomatic
Discuss with senior
Treatment for chemo-induced diarrhoea
Loperamide
Acute N+V
Within 24 hours of having chemo
Delayed N+V
More than 24 hours after chemo
Treatment for mucositis
Good oral hygiene - chlorhexidine mouthwash
Oromorph if in pain
Tranexamic acid mouthwash if bleeding
