Haematological emergencies Flashcards
(51 cards)
Does neutropenic sepsis always present with febrile neutropenia?
No
Patient can have neutropenia without fever
What are the 2 defining features of neutropenic sepsis?
Absolute neutrophil count is 0.5 x 10(9)/L or lower
Temperature greater than 38 degrees Celsius OR any symptoms/signs of sepsis
What is the main reason why neutropenic sepsis is a life-threatening emergency?
Neutropenic patients already have weakened immune system and are more likely to contract bacterial infections which can become disseminated and fatal
Give 4 haematological risk factors for neutropenic sepsis?
Recent chemotherapy (usually within 14 days): Biggest risk factor
Immunotherapy with cytotoxic drugs
Stem cell transplant patient
Bone marrow disorders
What treatment pathway is used for neutropenic sepsis?
Sepsis 6 care bundle
How does a patient with neutropenic sepsis start the sepsis 6 care bundle treatment?
Call 999 ambulance for emergency transfer to hospital, ideally within 1 hour of neutropenic sepsis recognition
What is included in the sepsis 6 care bundle, to treat neutropenic sepsis?
3 diagnostic and 3 therapeutic steps delivered within 1 hour after initial recognition of sepsis
- Oxygen administration
- Two sets of blood cultures
- Venous blood lactate
- Fluid resuscitation
- Appropriate antibiotics
- Monitor observations
How should oxygen be administered to treat neutropenic sepsis?
Give oxygen therapy to people with reduced oxygen saturation (below 92%) or with an increase in oxygen requirement over baseline, to maintain oxygen saturation above 94% unless contraindicated
How are the two blood cultures taken from the patient, in neutropenic sepsis treatment?
Paired cultures from a peripheral/central line in situ and periphery
What is the first line antibiotic for neutropenic sepsis and why?
Continuous IV piperacillin with tazobactam (tazocin)
Provides anti-pseudomonal cover
What hormone drug can you administer to patients with neutropenic sepsis and why?
Recombinant G-CSF eg. Filgastrim
Can be used as treatment and prophylaxis to prevent neutropenia
If a patient with neutropenic sepsis is allergic to penicillin, which antibiotic should be administered instead of tazocin?
Second-line: IV Meropenem
Tazocin contains penicillin so cannot be used
What are the 4 emergency sickle cell crises?
Vaso-occlusive crisis
Aplastic crisis
Sequestration
Acute chest syndrome
What is a vaso-occlusive crisis in SCD patients?
Sickled RBCs get stuck in microcirculation eg. capillaries and cause ischemic injury to organs and tissue
What is an aplastic crisis in SCD patients?
Bone marrow suppression usually due to infection of parvovirus B19 which stops RBC production for a short time
What is acute splenic sequestration crisis in SCD patients?
Sickled RBCs block blood vessels exiting spleen, so spleen becomes engorged with blood
Causes severe anaemia and life-threatening circulatory collapse
What is acute chest syndrome in SCD patients?
Vaso-occlusive crisis in pulmonary vasculature
What is the main symptom of sickle cell crises?
Sudden and intense pain throughout whole body
What is the management for sickle cell crisis (HOP to it)?
H: Hemodilution (IVF, PRBCs)
O: Oxygen supplementation
P: Pain relief
In sickle cell crisis, how is hemodilution managed in 2 steps?
Exchange transfusion: Machine replaces sickled blood with donor PRBCs
Intravenous fluids: Slows sickling process
In sickle cell crisis, how is oxygen supplementation managed?
Provide oxygen if below 95% on room air
In sickle cell crisis, how is pain relief managed?
Mild pain: Paracetamol/ibuprofen/naproxen
Moderate pain: Codeine, tramadol
Severe pain: Morphine, oxycodone
What are the 3 defining signs of acute chest syndrome in SCD patients?
Fever
Respiratory symptoms
Pulmonary infiltrate (opacity) on chest x-ray
What is TTP and why is it a haematological emergency?
Clots form in microcirculation which blocks blood flow to heart, kidney, brain and other organs
