2nd June [7-13th] Flashcards
Normal range of creatinine for men
97-157 umol/l
Normal range of creatinine for women
88-128 umol/l
Which drug may cause red urine on a haematology ward?
Dionirubicin
Symptoms of haemorrhoids
Bright red blood after wiping, anal pruritus, lumps, pain
What are the three signs that predict if smouldering myeloma will progress into MM
with 80% chance:
- FLC ratio of over 100
- Plasmocytosis 60%
- CS imaging [e.g. MRI] to show lytic lesions
Common drugs that cause postural hypotension
Diuretics, alpha-adrenoecptor blockers for prostatic hypertrophy, antihypertensive drugs, CCB.
Insulin, levodopa, tricyclic antidepressants can also cause vasodilation and orthostatic hypotension in predisposed patients.
What is tazocin?
piperacillin with tazobactam
When can it be used?
For management of neutropenic patients with fever suspected to be due to bacterial infection
What is an autologous blood transfusion?
Collection and re-infusion of patient’s own blood or blood components
What is GvHD?
Graft versus host disease
- when transplantation occurs and there’s a bodily reaction to the new blood/tissue as immune system thinks it is foreign
- often it’s very mild, but can affect QoL in certain cases
- can be life threatening
How common is GvHD?
About half people who have a transplant get it
Type sof GvHD
- Acute: happens first 100 days after transplant
- Chronic: happens after 100 days post-transplant
- Progressive: when acute GvHD progresses to chronic GvHD
- Overlap: when features of acute and chronic GvHD happen together
When are you likely to get GvHD?
When am I likely to get GvHD?
GvHD can occur at any time, so it’s important to report any symptoms after transplant to your team. However, the most common times to experience GvHD are:
When your immune cells start to come back and appear in your blood, usually a few weeks after your transplant.
When the medication that suppresses your immune system is reduced, usually a few months after you go home. The immune cells become more active, notice there’s a difference in your body’s cells and may start an attack.
If you have a donor lymphocyte infusion (DLI) – this is a top-up of donor cells which can sometimes be given if your new immune system needs a boost.
Ix for GvHD
Some symptoms are quite general and don’t always mean you have GvHD. Your medical team will perform tests that might include biopsies (skin or liver GvHD) or use a small camera to look closely at the organ (stomach or lung GvHD). These tests can confirm the GvHD diagnosis.
Tx for GvHD
What are the treatments for GvHD?
Treatment for GvHD varies depending on the organ involved. It can be broken down into:
Local - This includes creams for skin GvHD, drops for eye GvHD and physiotherapy for GvHD of the joints.
Oral - Immunosuppressive medication (cyclosporine, mycophenolate or tacrolimus) will be given before your transplant to suppress your immune system and allow new stem cells to grow. If you develop GvHD, the dose might need to be increased for a while to control your symptoms. Oral steroids may also be used for immunosuppression. Once the GvHD has improved, these medications will slowly be reduced again.
Intravenous - Might be used if oral medications don’t control the GvHD. This might require an admission into hospital for treatment.
In some cases, acute or chronic GvHD cannot be controlled with these medications so further treatment, such as extracorporeal photopheresis (ECP) or referral to a specialist might be needed.
GvHD in the skin, gut, mouth and liver
Skin
Symptoms: Acute and chronic skin GvHD symptoms are very similar. Your skin is likely to become dry, red and itchy and it could affect multiple areas of your body. This can affect your appearance, ability to regulate your temperature and lead to infection if the skin is broken.
Treatment: Some cases need no treatment and improve naturally. Mild cases are treated using moisturises or steroid cream. Medication to supress your immune system in more severe cases and treatments such as ultraviolet light and extracorporeal photopheresis (ECP) are possible options.
Gut
Symptoms: Gut GvHD could affect your mouth, oesophagus (food pipe), stomach and bowel. Acute gut GvHD usually affects the bowel. You could have sickness, diarrhoea, indigestion, cramping feelings and lack of appetite.
Treatment: Mild cases don’t need treatment but dehydration should be avoided by drinking lots of fluids. More severe cases might need anti-diarrhoea medication, painkillers to ease cramps and anti-sickness drugs to stop you feeling sick.
Mouth
Symptoms: Your mouth may become sore and dry because you aren’t producing enough saliva. This may lead to ulcers forming and can make your food taste unusual.
Treatment: Visit your dentist regularly if you have mouth GvHD. Practising good oral hygiene and using a steroid mouthwash may also help.
Liver
Symptoms: To begin with you might not feel anything but your doctor might find out that something is wrong by testing your liver function. If it becomes worse you may become jaundiced, (yellowing of skin) and your skin may itch. Your liver may also swell in size, causing abdominal pain.
Treatment: Steroids and other drugs to suppress your immune system.
GvHD in the lungs, eyes, muscles and joints, genitals
Lung
Symptoms: Your lungs can lose some of their flexibility and elasticity, making you feel short of breath, wheezy and prone to coughs and chest infections. You might find exercising becomes more difficult. If you experience any of these symptoms you should contact your medical team straight away.
Treatment: Tests such as lung function, chest X-rays, CT scans and sometimes bronchoscopies (a type of endoscopy that looks inside your airways) to find out what’s causing your problems and rule out infection.
Eyes
Symptoms: Your eyes may become itchy, dry and uncomfortable or they may water almost continuously. They may also be sensitive to bright light.
Treatment: Referral to an ophthalmology specialist that can prescribe a combination of eye drops, anti-inflammatories or antibiotics depending on your symptoms. Wearing sunglasses may also helpful.
Muscles & joints
Symptoms: Restricted movement and pain in the joints of your arms and legs, making tasks such as driving or climbing stairs more difficult. Some patients experience swollen joints.
Treatment: Physiotherapy can improve your symptoms and will involve doing lots of stretches and keeping your joints mobile.
Genitals
Symptoms: Women may experience vaginal dryness, narrowing of the vagina and ulceration in advanced cases - causing pain and discomfort during sex.
Men may experience sensitivity or a rash on their penis and it could be uncomfortable to pass urine. They may also experience problems maintaining an erection.
Treatment: Women will be referred to a gynaecologist that may prescribe a steroid cream or gel to combat dryness. Men will be referred to a urologist and may also be prescribed a steroid cream to reduce sensitivity.
