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23 Cards in this Set
- Front
- Back
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Name the three major concerns with leukaemia |
Infection Bleeding Hyperviscosity |
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What should be taken very seriously in leukaemia and what should be excluded? |
Non-specific confusion and drowsiness Hypoglycaemia |
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When should a neutropenic regimen be put in place? |
When WCC is below 1.0x10^9/L |
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What bloods should be taken in those with neutropenia? |
FBC INR U+Es LFTs Cultures 3x |
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Name 5 procedures that should be followed when carrying out the neutropenic regime |
Full barrier nursing Avoid IM injections (infected haematoma) Look for infection (mouth, axilla, perineum, IVI site) Wash perineum and clean moist skin Vital signs 4 hourly |
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Cut flowers pose a risk for what in neutropenia? |
Pseudomonas |
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When should be ABx be given in neutropenia? |
Known infection Temp >38.0c Temp >37.5c 1-2 hours apart |
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What blind combination therapy should be used to treat neutropenic infection? |
Aminoglycoside+Ceftazidime+Vancomycin (if gram+s) |
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How long is ABx continued for? |
72h afebrile or a 5 day course |
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Consider what if fever persists despite abx therapy? |
CMV Fungi such as candida or aspergillosis |
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Treat Pneumocystis with what? |
Trimethoprim 20mg/kg with sulfamethoxazole 100mg/kg/day PO/IV for 2 days |
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Which drug class can be used as prophylaxis to decrease mortality in acute leukaemia? |
Fluoroquinolones |
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Tumour lysis syndrome involves what? |
Massive destruction of cells due to chemotherapy |
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It causes what blood abnormalities? |
Increased urate Increased Potassium Renal impairment |
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What increases the risk of tumour lysis syndrome? |
High creatinine High LDH High urate High WCC as they are susceptible to lyse |
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Tumour lysis syndrome Rx? |
High fluid intake Allopurinol
Recombinant uricase (in severe cases) |
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Hyperviscosity is defined as a WCC of what? |
>100x10^9/l |
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What is a potentially deadly complication of hyperviscosity? |
Leukostasis - WBC thrombi forming in the brain or lung or heart and therefore causing infarction |
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What is the essential treatment for hyperviscosity before transfusing these patients? |
Lower WCC with hydroxycarbamide or leukopheresis |
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Name the third complication acutely of leukaemia |
DIC (Disseminated intravascular coagulation) |
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What will tests show in DIC? |
Increased PT, APTT Decreased firbrinogen Very increased D-dimers |
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Signs of DIC? |
Bruising (due to fibrin strands filling small vessels) Bleeding from any puncture site Renal failure |
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Rx for DIC? |
Replace platelets if <50x10^9/l Cryoprecipitate to replace fibrinogen FFP to replace coagulation factors Consider activated protein C in sepsis or organ failure |
