Emergencies in Pediatric Oncology (eBook)

Emergencies in PediatricOncology 3
Preface 7
Contents 9
Contributors 11
Chapter 1: Introduction: Pediatric Oncology 13
References 16
Chapter 2: Initial Management of New Diagnosis 17
Initial Contact 17
Arrival and First Steps in the Hospital 18
Management of Hyperleukocytosis 20
Leukapheresis 20
Solid Tumors/Brain Tumors 21
References 24
Chapter 3: Tumor Lysis Syndrome 25
Definition of Tumor Lysis Syndrome 25
Incidence 26
Presentation 27
Clinical Manifestations 28
TLS Treatment and Supportive Care 29
Treatment of Hyperkalemia 31
Treatment of Hyperphosphatemia 32
Treatment of Hypocalcemia 32
Summary 32
References 34
Chapter 4: Mediastinal Mass and Superior Vena Cava Syndrome 36
Anterior Mediastinum 37
Middle Mediastinum 37
Posterior Mediastinum 38
References 41
Chapter 5: Abdominal Masses 42
References 46
Chapter 6: Spinal Cord Compression and Cauda Equina Syndrome 47
References 51
Chapter 7: Fever and Neutropenia 52
Overview 52
Definitions 52
Etiology 53
Risk Factors 54
Assessment and Evaluation 54
Diagnostic Evaluation 55
Treatment 57
Antimicrobial Therapy 58
Indications for Central Venous Catheter Removal 59
Duration of Therapy 59
References 62
Chapter 8: Procedures 63
Chapter 9: Blood and Blood Product Transfusions 71
Overview 71
Informed Consent 71
Red Blood Cell Transfusion (PRBC) 72
Indications 72
Dosing 72
Infusion Time 73
Monitoring 73
Anticipated Response 73
Platelet Transfusion 73
Indications 74
Dosing 74
Infusion Time 74
Monitoring 75
Anticipated Response 75
Special Product Requirements 75
Irradiation 75
CMV-seronegative products 76
Noninfectious Complications 76
Management of Transfusion Reactions 77
Pretreatment for Recurrent Reactions 78
References 78
Chapter 10: Thromboembolism in Children with Cancer 79
Introduction 79
Anatomical Site of Thrombosis 79
Deep Venous Thrombosis 81
Right Atrial Thrombosis 81
Pulmonary Embolism 82
Risk Factors Predisposing to the Development of PE 82
Complications and Outcome of PE 82
Evaluation of a Child with Suspected Thromboembolism 82
Management of Thrombosis in Children with Cancer 83
Anticoagulation Therapy in Children with Cancer 83
Choice of Anticoagulant Agent 83
Management of Anticoagulation Therapy Around Invasive Procedures 86
Management of Anticoagulation Therapy in the Presence of Thrombocytopenia 86
Management of Asparaginase Therapy in a Child with TE 87
Role of Antithrombin Replacement in Patients on Asparaginase Therapy 87
Primary Thromboprophylaxis for CVL-related TE 87
Secondary Thromboprophylaxis Following Development of TE 88
References 88
Chapter 11: Cerebral Sinovenous Thrombosis in Children with Cancer 90
Introduction 90
CSVT in Children with Cancer 91
Anatomy of Cerebral Sinovenous System and Pathogenesis of CSVT 91
Etiology of CSVT in Children with Cancer 92
Clinical Presentation 93
Diagnosis of CSVT in Children 94
Principles of Management of CSVT 94
Principles of Supportive Care 95
Anticoagulation 95
Duration of Anticoagulation 96
Thrombolytic Therapy 96
Outcome of Patients with CSVT 96
References 96
Chapter 12: Central Venous Line-related Thrombosis 98
Complications of CVL 99
CVL Occlusion 99
Nonthrombotic Causes of CVL Dysfunction/Occlusion 99
Thrombotic CVL Occlusion 101
Evaluation and Management of Patients with Thrombotic CVL Occlusion 102
CVL-Related Thrombosis 102
Complications of CVL-Related Thrombosis [ 2, 4, 12– 15 ] 103
Diagnosis of CVL-Related Thrombosis [ 3, 12, 16, 17 ] 104
Management of CVL-Related Thrombosis 105
References 109
Chapter 13: Chemotherapeutic Drugs 111
Introduction 111
Classes of Chemotherapeutic Drugs 111
Methotrexate Clearance and Toxicity 115
Hypersensitivity Reactions Related to Chemotherapeutic Agents 116
References 125
Chapter 14: Supportive Care 127
Pathophysiology of Nausea and Vomiting 128
Pneumocystis Prophylaxis 129
Antifungal Prophylaxis in Pediatric Oncology Patients 134
Electrolyte Replacement 138
Granulocyte Colony-Stimulating Factor (G-CSF) 138
Recommendations for Use of CSFs in Pediatric Oncology Patients 141
Dosing and Administration of CSFs 141
Side Effects of CSFs 142
Menses Suppression (Therapeutic Amenorrhea) 142
References 146
Chapter 15: Abdominal Complications 148
Introduction 148
Constipation 149
Definition 149
Prevalence and Diagnosis 149
Management 150
Definition of Typhlitis 150
Prevalence and Diagnosis 151
Management 152
Definition of Pneumatosis Intestinalis 152
Prevalence and Diagnosis 153
Management 153
Definition of Pancreatitis 153
Prevalence and Diagnosis 154
Management 154
Summary 155
References 157
Chapter 16: Emergency Radiation Therapy in Pediatric Oncology 159
Introduction 159
Principles of Radiation Therapy 159
Mediastinal Masses 160
Rationale and Evidence 160
Technique 161
Expected Side Effects with Recommended Doses/Fractionations 161
Summary 165
Abdominal Masses 165
Rationale and Evidence 165
Technique 166
Expected Side Effects 166
Summary 169
Spinal Cord Compression 170
Rationale and Evidence 170
Technique 172
Expected Side Effects 172
Summary 174
Critical Neurologic Losses 175
Rationale and Evidence 175
Technique 175
Expected Side Effects 176
Summary 176
Conclusion 183
References 183
Index 185