AML in the Emergency Room - April 2, 2012

Thank you to Dr. Raymond Jang for hosting, and to team 8 for brining the case.

Briefly, a young man with previous AML (treated with allogenic stem cell transplant 5 years ago) presented with fever, chills, and tachycardia.  He also has graft vs. host disease and previous line infections (pseudomonas and CNST), and still has indwelling lines.

We talked about the key considerations when a patient presents to the Emergency Department with a cancer related issue.  It is important to know:

- Is the patient sick or not sick?

- What cancer treatments had been received so far and their responses?

-  Is treatment curative or palliative?

- What is the prognosis?

- Is there anything reversible?

- What are the complications of cancer itself or its treatments?

For AML, there are 5 complications that we focused on today:

-  Fever/infection:  This is what our patient presented with.  We talked about the importance of looking for a source and controlling the source, appropriate antibiotics (this patient had previous pseudomonas infection, and CNST), and fluid resuscitation.

-  Tumour lysis syndrome (TLS).  We unfortunately did not have enough time to talk about this.  You can read more here.

-  Disseminated intravascular coagulation (DIC).  Diagnosed with blood film, INR, PTT, and fibrinogen.  Support with blood products (including fresh frozen plasma and cryoprecipitate as appropriate).

-  Leukostasis.  We talked about the main organs at risk are brain, heart, and lungs.  We talked briefly about the agent hydroxyurea.

-  Cytopenias.  This is managed supportively with blood products.

You can read more about AML here and Graft vs. Host disease here.