Pediatric emergency medicine trisk 2713 2713
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SECTION II: MANAGEMENT OF COMPLICATIONS ASSOCIATED
WITH CANCER AND CANCER THERAPY
This section focuses on the complications of cancer treatment that are likely to lead
to an ED visit for care. The systems-based review of management below focuses on
the initial care of the patient and does not address the more detailed evaluation and
management needed subsequently. Complications of specific chemotherapeutic
agents are listed in Table 98.8 .
HEMATOLOGIC COMPLICATIONS OF CANCER TREATMENT
Goals of Treatment
Cytopenias are common in both newly diagnosed cancer patients as well as those
undergoing active therapy, and a high index of suspicion should be maintained for
all of these patients.
CLINICAL PEARLS AND PITFALLS
Patients receiving chemotherapy should be presumed to be neutropenic
and isolated from the potential sources of infection that exist in the ED as
soon as possible.
Patients with thrombocytopenia requiring procedures may benefit from
platelet infusion during the procedure itself.
Current Evidence
Many chemotherapeutics cause reversible myelosuppression. Neutrophils have a
very short half-life and thus their numbers may drop rapidly after initiation of
treatment, but also may recover quickly. Platelets have a slightly longer half-life and
thus tend to drop and recover slightly more slowly. Because red blood cell half-life
is over 100 days, chemotherapy effects on red cells tend to be more chronic than
acute. The nadir blood counts usually occur 7 to 10 days after start of treatment and
recovery usually occurs 10 to 14 days after start of treatment. The pattern of
myelosuppression differs by chemotherapy regimen. For example, most solid tumor
regimens allow for complete recovery within 10 to 14 days, while acute
myelogenous leukemia regimens may delay recovery until 4 to 6 weeks after
treatment. Even within a given regimen, there is variation both among patients and
among cycles for one patient. In general, recovery is slower for patients who have
already received many cycles of chemotherapy, whose course has been complicated
by infection, or whose bone marrow has been extensively replaced by tumor.
