Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Oncologic And Hematologic Emergencies

Oncologic And Hematologic Emergencies

Pdf Summary

The document titled "Oncologic and Hematologic Emergencies" by Dr. Asya Agulnik, is a comprehensive guide focused on recognizing and managing life-threatening complications associated with pediatric malignancies and their treatments. The document outlines several critical complications and the necessary management strategies for pediatric cancer and the adverse effects of cancer-directed therapies.<br /><br /><strong>Key Points:</strong><br /><br />1. <strong>Hyperleukocytosis:</strong> Defined by a high peripheral leukocyte count which can cause complications such as CNS hemorrhage, pulmonary leukostasis, and renal failure. Management includes hydration, allopurinol, and emergent correction of thrombocytopenia and coagulopathies. Leukopheresis is rarely indicated.<br /><br />2. <strong>Tumor Lysis Syndrome (TLS):</strong> Characterized by the rapid release of intracellular contents leading to hyperuricemia, hyperkalemia, and hyperphosphatemia. Management involves identifying at-risk patients, monitoring electrolytes, hydration, allopurinol, and managing specific electrolyte imbalances.<br /><br />3. <strong>Mediastinal Masses:</strong> Often present with symptoms like shortness of breath, dysphagia, and symptoms of superior vena cava (SVC) syndrome. High sedation risks call for cautious management of respiratory and hemodynamic stability. Diagnostic evaluations should prioritize non-invasive strategies like CT scans.<br /><br />4. <strong>Spinal Cord Compression:</strong> Typically seen in metastatic or relapsed diseases. It needs prompt management with dexamethasone and can require surgical resection, chemotherapy, or radiation.<br /><br />5. <strong>Febrile Neutropenia:</strong> Defined by significant neutropenia and fever, represents a medical emergency requiring a swift infectious workup and broad-spectrum antibiotics. Increased infection risks correlate with prolonged neutropenia.<br /><br />6. <strong>Typhlitis (Neutropenic Enterocolitis):</strong> Characterized by abdominal pain, fever, and neutropenia. Managed with supportive care, broad-spectrum antibiotics, and occasionally surgery.<br /><br />7. <strong>Chemotherapy Toxicities:</strong> Can affect various systems including central nervous, cardiac, pulmonary, and renal systems. Management involves supportive care, discontinuation of the offending agents, and addressing specific symptoms.<br /><br />8. <strong>Acute Chest Syndrome:</strong> Affects sickle cell patients, requiring antibiotics, oxygen therapy, and possibly transfusions.<br /><br />The document emphasizes the importance of understanding and promptly addressing these complications to improve outcomes for pediatric cancer patients.

Keywords

Oncologic Emergencies

Hematologic Emergencies

Pediatric Malignancies

Cancer Complications

Hyperleukocytosis

Tumor Lysis Syndrome

Mediastinal Masses

Spinal Cord Compression

Febrile Neutropenia

Chemotherapy Toxicities

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