Haematological Emergencies Flashcards Preview

Phase 2a medicine > Haematological Emergencies > Flashcards

Flashcards in Haematological Emergencies Deck (18):
1

Febrile neutropenia
Who is at risk? (4)

- Chemo > 6 weeks ago
- Stem cell transplant/high dose chemo < 1 year
- Aplastic anaemia/leukaemia/autoimmune disease
- People on METHOTREXATE, CARBIMAZOLE, CLOZAPINE

2

Febrile neutropenia
Clinical presentation

Temp > 38 degrees Celsius
Absolute neutrophil count < 1X10/L

- Malaise
- Sweats / rigors
- Cough / sore throat
- Abdo pain
- Diarrhoea
- Pain around central venous catheter
- Tachycardia
- Hypotension
- Raised resp rate

3

Febrile neutropenia
Management

- Start broad-spec antibiotics (IV) within 1hr of admission
- Do NOT catheterise (increased infection risk)

4

Malignant spinal cord compression
Who is at risk?

- Bone mets and vertebral collapse
- Local tumour extension
- Deposition of malignant cells within cord
- Commonly seen in MYELOMA and LYMPHOMA

5

Malignant spinal cord compression
Clinical presentation

- Back pain
- Weakness/numbness in legs
- Inability to control bladder/bowel
- Saddle parasthaesia
- Decreased perianal sensation and anal tone

6

Malignant spinal cord compression
Management

- TIME = NERVES
- Strict bed rest
- High dose steroid, e.g. ORAL DEXAMETHASONE
- Analgesia
- Urgent MRI of whole spine

7

Tumour Lysis Syndrome
Define

Life-threatening metabolic derangement that occurs when malignant cells BREAKDOWN -> resulting in neuro, cardio and renal complications.

8

Tumour Lysis Syndrome
Clinical presentation

- High uric acid
- Hyperkalaemia
- Hyperphosphataemia
- Hypocalcaemia

9

Tumour Lysis Syndrome
Who is at risk?

- High tumour burden
- High grade disease (rapid cell turnover)
- Pre-existing renal impairment
- Increasing age
- Drugs that increase uric acid formation (e.g. alcohol)

10

Tumour Lysis Syndrome
Management

- Aggressive hydration
- ALLOPURINOL or RASBURICASE (reduce uric acid production)
- Monitor electrolytes
- Refer for dialysis if needed

11

Hyperviscosity Syndrome
Define

Increase in blood viscosity, usually due to high immunoglobulins

12

Hyperviscosity Syndrome
Seen in?

Myeloma and Waldenstrom macroglobulinaemia
Or increased cell numbers -> Leukaemia/Polycythaemia

13

Hyperviscosity Syndrome
Result in?

Vascular stasis
Hypo-perfusion

14

Hyperviscosity Syndrome
Clinical presentation

- Mucosal bleeding
- Visual changes
- Neuro changes
- SOB
- Fatigue/anorexia
- Bruising/bleeding gums
- Ataxia/nyastagmus

15

Hyperviscosity Syndrome
Diagnosis

- Plasma viscosity level
- CT head - to exclude other signs
- Immunoglobulin levels
- FBC

16

Hyperviscosity Syndrome
Management

- Hydration
- AVOID blood transfusions - will make blood thicker
- Plasmapharesis - removes circulating Ig's

17

Hypercalcaemia
Clinical presentation

- Confusion
- Bone pain
- Constipation
- Nausea
- Polyuria
- Abdo pain
- Anorexia
- Renal stones
- Shortened QT intervals --> CARDIAC ARREST

18

Hypercalcaemia
Treatment

- IV HYDRATION -> 3-4 L/day
- BISPHOSPHONATES, e.g. Zolendroanate - reduces Ca production. Takes a few days to be effective.