1. Leukostasis is a medical emergency and requires emergent intervention.
- High mortality rate (up to 40%)!
- Can cause end organ damage - may present with neuro symptoms (like ischemia).
- Start IV Fluids to dilute the WBC.
- Hydroxyurea can also help decrease WBC.
2. Always consider tumor lysis syndrome in any child who recently started chemotherapy.
- Seen with conditions with large tumor burden (ex, large solid tumor, leukemia).
- Look for High Potassium, High Phosphorous, and LOW Calcium!
- Start IV Fluids
- Check ECG. Treat Hyperkalemia!
- Rasburicase for elevated uric acid.
3. It's okay to wait for the results of a CBC with diff in stable appearing patient on chemotherapy with a fever.
- Neutropenic Fever untreated has a high mortality (80%), but treated appropriately it is 1-3%.
4. Involve oncology early whenever one of their patients arrive in the CED.