Oncologic Emergencies



Oncologic Emergencies


Zaid Al-Harbash



Introduction



  • Incidence of childhood malignancy 1:100,000


  • Most common: leukemia, followed by solid tumors of the brain and spinal cord


Fever and Neutropenia



  • Infections remain the major cause of morbidity and mortality among cancer patients


  • Most common bacterial organisms found in febrile neutropenia: Staphylococcus, Streptococcus, Enterococcus, Corynebacterium, E. coli, Klebsiella, Pseudomonas


  • Neutropenia is defined as absolute neutrophil count (ANC) < 0.5 × 109/L, or 0.5-1 × 109/L and expected to fall


  • Absolute neutrophil count is the sum of all mature and band forms of polymorphonuclear cells


Risk of Infection




















Bacteremia or sepsis


12-32%



Pneumonia


3-13%



Urinary tract infection


1-5%



No documented infection


67%



Clinical Assessment



  • Obtain thorough history and examine for sites of infection


  • Pay special attention to:



    • Mucosa and perioral areas, skin, and perianal areas for ulcerations or lesions


    • Central line for cellulitis



    • Abdomen for typhlitis or neutropenic colitis


  • Signs of inflammation may be minimal in neutropenia:



    • Abscess may manifest as pain without erythema or swelling


    • Pneumonia may manifest as tachypnea alone


Investigations



  • CBC and blood cultures should be taken peripherally and from the central line


  • Obtain peripheral cultures immediately on arrival in the emergency department


  • Urinalysis and culture: avoid catheterization in neutropenic patients


  • Chest X-ray in patients with respiratory symptoms


Treatment



  • Initiate antibiotic therapy immediately if febrile and neutropenic


  • Involves IV dual therapy with a β-lactam and aminoglycoside


  • Add vancomycin if suspect central line infection


  • If signs of perirectal involvement, consider anaerobic coverage


  • If signs of herpes simplex virus or varicella zoster virus infection, add acyclovir


  • Admit and monitor with hourly vital signs for first 4 hours and then q 4 h as indicated


Tumor Lysis Syndrome

Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Oncologic Emergencies

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