Hematology and Oncology

Fever and Neutropenia

Fever>38.3 x 1 or 38.0 >1 hr
Neutropenia <500 or <1000 and falling

Workup:
- Blood culture from all ports and lines
- CBC with diff and LTM
- Urine Culture x 1
- Wound, stool, CSF and others as clinically indicated
- CXR as indicated
- Check prior record of positive cultures.

Empiric antibiotic treatment:
- Cefepime (50 mg/kg)
- Add aminoglycoside if Pseudomonas prevalent or toxic/septic appearing
- Consult ID

Hyperleukocytosis

1. WBC >100,000
2. Obstruct circulation in brain, lung, other organs forming white thrombi
3. Compete for O2 and damage vessel wall
4. Therapy:
- Hydration
- 2-4 Maintenance
- Alkalinization 50-100 mEq Na HCO3/L
- Allopurinol 100 mg/m2 q 8hr
- Monitor lytes and uric acid q 6hr
5. Monitor coags, platelets AVOID diuretics

Tumor Lysis Syndrome

1. Results from tumor cell death
2. Release K⁺, phosphate, nucleic acids into circulation
3. Hypocalcemia, hyperuricemia
4. Renal failure
5. Occurs before therapy or up to 5 days after initiation
6. Management-
- Hydration- no potassium
- 3-4L/m2/day
- D5 ¼ NS + 50-100 NaHCO3 mEq/L
- Maintain Urine s.g. <1.010
- Allopurinol 100 mg/m2 po q 8hr
- Manage Hyperkalemia
- Hemodialysis in severe cases

Superior Vena Cava Syndrome (SVCS) and Superior Mediastinal Syndrome

- Medical Airway Emergency due to sx of compression, obstructio, or thrombosis of SVC.
- Classic signs and symptoms include plethora, facial edema, conjunctival suffusion, and JVD.
- CXRay is diagnostic but may due CT if tolerated by patient in supine position.
- Empiric treatment with steroids (methylprednisolone 1 mg/kg IV every 6 hr, along with empiric irradiation