Kedaruratan Onkologi

Hematologic emergency

Leukostasis (Hyperleukositosis)

Tumor lysis syndrome

Febrile neutropenia
 Leukostasis
Symptoms
CNS: headache, confusion, t innitu s,
papilledema, ataxia, stupor,
hemorrhage
Lungs: dyspnea, hypoxemia

Others
 Treatment
Leukapheresis

Hydration

Chemotherapy 2

Hydrox yurea 50 -100 mg/kg

 Hydration

- C 1:2 dengan jumlah 1,5 x HS

- PU + IWL pada gizi buruk

dr. Sony W Sp.A

 Leukopheresis

Darah diambil dari pasien dan diletakkan melalui

sebuah pemisah sel darah dimana sel2 darah putih
diambil, Sisa dari darah kemudian dikembalikan pada
aliran darah pasien.
2
Definition

Fever/febrile
A body temperature > 380C three times in 24
hours or > 38.50C once
Lanzkowsky P. Manual of Pediatric Hematology and Oncology 2005

A single oral temperature ≥ 38.30C or ≥ 38.00 C

for 1 hour continuously or at two times within a
minimum time interval of 12 hours
Hughes WT, et al. Clinical Infectious Diseases 2002
Mendes AV, Sapolnik R, Mendonça N. J Pediatr (Rio J) 2007
General Approach to Management
1.Initial evaluation: clinical workup & risk assessment
2.Empiric Antibiotic
3. Culture
4. Antifungal therapy

Hughes WT, et al. Clinical Infectious Diseases 2002

Characteristic findings of Tumor lysis syndrome
include:
Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
 Clinical manifestations
 Hyperuricemia: lethargy, nausea, vomiting & renalfailure

 Hyperphosphatemia may precipitate hypocalcemia and cause

tissue damaga due to ca.phosphate precipitation in tissues

 Tissue damage may present as pruritic skin or gangrenous

skin lesions, arthritis, eye inflammation or as renal failure

 Hypocalcemia can present as tetany, carpopedal spasm, cramps,

seizures, alteration in sensorium or as cardiac arrest

 Arrythmias, neuromuscular symptoms due to hyperkalemia

and hypocalcemia may lead to sudden death
 TREATMENT

Hydration
 Hyperkalemia correction
 Hypocalcemia correction
 Alkalinization
 Hypo uricemic Drugs
 For patients who have acute renal failure, signicant
uremia, or severe electrolyte abnormalities associated with
tumor lysis syndrome, hemodialysis should be initiated as
soon as possible.

delay in starting hemodialysis for acute renal failure may turn

a potentially reversible clinical situation into an irreversible
one
 OBSERVASI

 Serum creatinine, blood urea nitrogen, sodium,

potassium, calcium, phosphorous,and uric acid
Terimakasih