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Neutropenic Sepsis-Tls-Anaphylaxis-Extravasation
Neutropenic Sepsis-Tls-Anaphylaxis-Extravasation
(Sepsis)
Dr. Sumayya Latif
Definition of Fever in Febrile
Neutropenia
A single oral temp 38.3 C (101 F)
OR
OR
•
Ø 1000/mm3 and predicted nadir of
500/mm3
•
Absolute Neutrophil Count
(ANC)
• Prophylactic antibiotics
üFlouroquinolones:
Levofloxacin/ ciprofloxacin
Anaphylaxis ass. with
Anti-cancer drugs
Drugs causing anaphylaxis
Ass particularly with:
• Paclitaxel
• Carboplatin
• Docetaxel
• L-asparaginase
Presentation
• Agitation
• Hypotension
• Chest tightness
• Bronchospasm
• Laryngeal edema
• Rash
• Angioedema
• Urticaria
• Abdominal pain
• Tongue swelling
Prevention
Prophylactic steroids and antihistamines reduce the
incidence of hypersensitivity reactions to taxanes and
carboplatin
Management
• Stop the drug infusion
• Secure ABC
• Give O2
• Lie the patient flat and elevate the legs if hypotensive
• If there is stridor, wheeze, respiratory distress or clinical
signs of shock:
Adrenaline (epinephrine; 1:1000 solution) 0.5 ml I/M and
repeat the dose after 5 minutes if there is no improvement
• Chlorphenamine 10 mg I/V
• For all severe or recurrent reactions: Hydrocortisone
200 mg I/V
• If shock fails to respond to drug measures, give 1–2 L of
I/V crystalloid
Tumor Lysis Syndrome
Etiology
• Caused by sudden tumour necrosis either due to
treatment or occurring spontaneously
TLS is associated with:
• Chemosensitive, bulky tumours such as high-grade
lymphoma, acute leukaemia and Burkitt lymphoma. It is
rarely seen in low-grade lymphomas or solid tumours
• Pre-existing renal failure---contributory factor
• Patients with lymphoma who have a raised lactate
dehydrogenase (LDH) (> 1500 IU/L) are likely to have
a high tumour burden and are at increased risk
Presentation
• Non-specific symptoms:
weakness, nausea, vomiting, myalgia and dark urine
• Electrolyte imbalance:
K+ uric acid PO4 Ca++
which can result in arrhythmias, neuromuscular
irritability, seizure and death
● Factors ● Description
Radiotherapeutic Previous local radiotherapy, radiation
recall reactions
Mechanical Needle insertion technique, multiple
venepuncture sites
Vein physiology Fragile, small, sclerosed
Pharmacological Duration and chemotherapy dosage
exposure to tissue
Physiological SVCO, lymphoedema, peripheral
neuropathy, phlebitis
Presentation
• Pain and swelling at the site of the I/V cannula
More seriously, it can result in:
• Ulceration, necrosis, sloughing of the skin, damage
to underlying structures and permanent disability
Management
• Stop infusion, disconnect tubing, but leave I/V cannula
in situ
• Aspiration of vesicant
• Administer antidote
• Keep limb elevated---24-48 hrs
• Cold or warm compression as indicated:
üFor 30 to 60 minutes and then 15 minutes off and on for 1
day
üAvoid applying pressure
• Adequate Analgesia
• Estimate the amount of extravasated drug
Antidotes
● Drug ● Antidote
● Anthracyclines / Mitomycin • Topical DMSO (dimethyl sulfoxide) 50%
• Topical hydrocortisone cream 1%
● Vinca Alkaloids / Platins/ • Infiltrate the site with hyaluronidase (1500 units
Taxanes of hyaluronidase in 1 mL of water for injection)
using 0.2 mL injections over and around the
affected area
• Topical NSAID cream
● Anti-metabolites • Topical hydrocortisone cream
Surgical debridement
Consultation:
• Lesions that are large
• Lesions on the hand or wrist