Leukemia Emergencies - Dr. Smith

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.

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