Acute Lymphoblastic Leukemia (ALL) Emergency Treatment

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Questions and Answers

What is the most important aspect of treating disseminated intravascular coagulation (DIC)?

Conducting laboratory investigations

Administering IV vitamin K

Treating the underlying cause (correct)

Providing fresh frozen plasma

Why may patients receiving large amounts of plasma expanders and RBCs experience abnormal bleeding?

As a result of Von Willebrand Disease

Due to a deficiency in vitamin K

Due to the development of DIC

Because of dilutional coagulopathy (correct)

What is essential when investigating abnormal PT or APTT results?

Administering fresh frozen plasma

Measuring plasma levels of vWF

Considering patient history and potential factor deficiencies (correct)

Conducting a thorough physical examination

Why may Von Willebrand Disease often be missed?

Because standard tests like PT, APTT, and platelet count may appear normal Signup and view all the answers

What should be ensured when collecting blood samples for laboratory investigations?

That the sample tubes are filled to the mark Signup and view all the answers

What is a major manifestation of disseminated intravascular coagulation (DIC)?

End-organ damage due to microvascular thrombosis Signup and view all the answers

What is used to treat bleeding or prevent hemorrhage associated with planned invasive procedures in patients with DIC?

Fresh Frozen Plasma (FFP) and platelet concentrates Signup and view all the answers

Why may abnormal bleeding occur in patients receiving massive transfusions?

Due to dilutional coagulopathy Signup and view all the answers

What is the percentage of children with ALL that have t(9;22) translocation?

5% Signup and view all the answers

What is the primary concern in the emergency treatment of ALL?

Cardiovascular and respiratory resuscitation Signup and view all the answers

What is the purpose of administering broad-spectrum antibiotics in the emergency treatment of ALL?

To prevent neutropenic sepsis Signup and view all the answers

What percentage of adults with ALL have t(1;19) translocation?

Not mentioned in the text Signup and view all the answers

What is the primary site of involvement in 15% of ALL cases?

Mediastinum Signup and view all the answers

What is the percentage of children with ALL that have abnormal cytogenetic analysis?

85% Signup and view all the answers

What is the primary goal of leukapheresis procedure in ALL?

Not mentioned in the text Signup and view all the answers

What is the primary infection prophylaxis strategy in ALL?

Administering antibiotics Signup and view all the answers

What is the indication for leukapheresis in patients with ALL?

High peripheral blast count or signs of leukostasis Signup and view all the answers

Which of the following is a key component of infection prophylaxis in ALL patients?

Emphasis on hygiene and infection control measures Signup and view all the answers

What is the primary goal of hydration management in ALL patients during induction therapy?

Maintain urine output >100mL/h Signup and view all the answers

What is the significance of collaborative approach in managing ALL emergencies?

It is essential to optimize patient outcomes Signup and view all the answers

What is the purpose of inserting a tunneled central venous catheter in ALL patients?

For chemotherapy administration Signup and view all the answers

What is the significance of monitoring for Tumor Lysis Syndrome (TLS) in ALL patients?

It is necessary to initiate IV fluids and consider allopurinol or rasburicase Signup and view all the answers

What is the purpose of initiating a neutropenic regimen in ALL patients?

To prevent infections Signup and view all the answers

Why is it necessary to use irradiated products for patients treated with purine analogues?

To prevent complications associated with transfusions Signup and view all the answers

Study Notes

Emergency Treatment of ALL

Consider leukapheresis if peripheral blast count is high or signs of leukostasis are present (e.g., retinal hemorrhage, reduced conscious level, diffuse pulmonary shadowing on CXR, or hypoxia)

Collaborative Approach

Emphasize the importance of immediate action and collaboration with experts to optimize patient outcomes
Highlight the significance of prompt recognition and intervention in managing ALL emergencies

Supportive Treatment of ALL

Patient Education and Counseling: explain leukemia diagnosis and treatment process, offer counseling to alleviate distress associated with prolonged chemotherapy
Transfusion Support: provide RBC and platelet transfusions throughout treatment, use irradiated products for patients treated with purine analogues, and maintain platelet count >10 × 10^9/L
Infection Prophylaxis: initiate neutropenic regimen to prevent infections, emphasize hygiene and infection control measures
Hydration Management: start hydration to maintain urine output >100mL/h during induction therapy
Tumor Lysis Syndrome (TLS): monitor for TLS, initiate IV fluids and consider allopurinol or rasburicase in high-risk cases
6-Mercaptopurine Interaction: be aware of interaction with allopurinol, adjust allopurinol dose or consider rasburicase instead to prevent adverse effects
Central Venous Catheter Insertion: insert tunneled central venous catheter for chemotherapy administration, ensure proper care and maintenance to prevent complications

Cytogenetic Analysis

Provides important prognostic information in both children and adults
Can be used for Minimal Residual Disease (MRD) detection
Abnormalities detected in up to 85%
If no structural abnormalities present, abnormalities are classified by the modal chromosome number
t(9;22), the Philadelphia (Ph) chromosome, found in 5% of children and 25% of adults with ALL: very strong adverse prognostic factor in both
t(1;19) associated with precursor B-cell ALL

Clinical Features

Acute presentation usual; often critically ill due to BM failure
Anemia: weakness, lethargy, breathlessness, lightheadedness, and palpitations
Infection: particularly chest, mouth, perianal, skin (Staphylococcus, Pseudomonas, HSV, Candida)
Fever, malaise, sweats
Hemorrhage: purpura, menorrhagia, and epistaxis, bleeding gums, rectal, retina
Bone or joint pain is more common in children
Mediastinal involvement in 15%; may cause Superior Vena Cava (SVC) obstruction especially T-ALL
CNS involvement in 6% at presentation; may cause cranial nerve palsies especially facial nerve, sensory disturbances, and meningism
Signs include widespread lymphadenopathy in 55%, mild-to-moderate splenomegaly (49%), hepatomegaly (45%), and orchidomegaly

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Description

This quiz covers the emergency treatment of Acute Lymphoblastic Leukemia (ALL) including leukapheresis and collaborative approaches.