Oncological emergencies - Myelosuppression
Oncological emergencies - Myelosuppression
Chemotherapy used for the treatment of cancer may kill the good and bad cell as a result of bone marrow suppression. The good cells are the hematological progenitor cells. It is important to monitor the side effect of cancer treatment as it may leads to death. Neutropenic sepsis is very common to occur in patient cancer treatment. It will leads to mortality rates around 20% to 30% if left untreated. Patient who suffers from neutropenic sepsis will suffer from fever, rigor and oral ulceration associated with candidiasis. Neutropenic sepsis patient is diagnosed/defined based on the septic symptoms in the present of white cell count that is < 1* 10 *9/L. It is a standard practice to admit the patient to the hospital.
Resuscitate the patient with intravenous fluid and blood culture are taken. The advantageous of taking the culture from other sites rather than blood is zero. In the absence of any infection such as urinary tract infection , taken the vulture other than from the blood is beneficial. In the case of neutropenic sepsis, however only 20% of blood culture are positive for the present of bacterial organism. The causes of infection remain unknown.
Based on the recent study, the usage of single agent ceftazidime is as effective as a treatment of neutropenic sepsis with combination of antibiotics. However the hospital policy regarding the usage of antibiotics ( antibiotic policy ) vary from hospital to hospital. In one randomized controlled trial , the treatment in the community with oral ciprofloxacin and in patient treatment with intravenous ceftazidime produce the same effect in term of controlling the fever as well as the patient outcome.
Granulocytes - colony stimulating factors ( G - CSF ) has been available as marrow growth factor. G- CSF responsible in stimulating marrow to produce granulocytes. There is no or poor evidence of the usage of G -CSF as prophylatic to prevent neutropenic sepsis or patient with establish neutropenic sepsis. It is of value in patient with establish neutropenic sepsis with infective agent identified and suffer from non recovering marrow. The usage of G- CSF is also useful in transplantation as it reduces the engraftment period from 28 days to 18 days.
Anemia is a common complication of the cancer and the treatment for cancer. Almost 30% of patient requires blood transfusion. Anemia is a build up or cumulative effect of the cycle of chemotherapy. Alternative to blood transfusion include recombinant erythropoietin. Hemoglobin level increase after treatment with recombinant erythropoietin after 6 weeks. The positive response is detected around 20% to 60% patient. .The price of recombinant erythropoietin is highly expensive however the price will be affordable soon as the cost of blood transfusion is getting higher due to extra step taken to screen the blood for Creutzfeldt- Jakob - Diseae ( CJD). The pharmaceutical market promotes recombinant erythropoietin as treatment for cancer fatigue or asthenia rather than improving the hemoglobin level.
Most commonly occurs during the treatment of hematological malignancy rather than treatment of solid tumor. Patient at a high risk of spontaneous bleeding when platelet count is less than 10 -20 * 10*9 /L. Prophylatic platelet is transfused by oncologist at this level or when the bleeding occur. IL- 1. IL 6 and IL -11 are the new regulatory molecules that stimulates early haemotopoietic progenitors cells. IL 1 and IL 6 have significant toxicity and poor efficacy while IL 11 is used for prevention of chemotherapy causing thrombocytopenia. Analogues of thrombocytopenia are the new agents that has been the focus of pharmaceutical company as replacement to interleukin or IL
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