Leukemia
What does AML stand for?
Acute Myeloid Leukemia
What does MDS stand for?
Myelodysplastic Syndrome
Is it cureable?
No
What things would you expect need to be done for a work up?
1. Labs
2. Bone Marrow Biopsy
3. Echo
4. Central Line
Can you stage lymphoma?
Yes
What are the major factors that would decide if a patient gets 7+3 or Aza Ven?
Age, Heart, Comorbidities and Functional Status
What are infusion parameters?
Platelets- <10 [Different if impending surgery, bleeding]
PRBC - <7 [Cardiac Hx, Ex Heart Failure]
What is the treatment method for someone with multiple myeloma?
Using a treatment method until the disease does not respond and then go to a new line. At some point getting a stem cell transplant
Do you always need a bone marrow biopsy for a new work up?
No, sometimes a peripheral smear may be enough
Patient comes in age of 22 with swollen lymph nodes in his neck. Are you thinking more likely Hodgkins or Non-Hodgkins Lymphoma?
Hodgkins
What is the big teaching point with a CML patient?
Medication Compliance
Can you have AML without having MDS?
Yes
Your taking care of a patient with multiple myeloma and are stressing education on falls? Why are you so stressed about falls?
High Risk of Fracture
(Patient broke arm opening door handle)
What are the things you need to make sure you do for a Bone Marrow Biopsy?
1. Make sure the patient goes to the bathroom
2. Educate patient they will need to lay flat for 1 hour post
3. Educate patient to notify team of headaches, changes in sensation, bladder/bowel changes
4. Put down chux on bed
5. Printer for labs/Lab bag
6. Complete a Time Out
PICC vs PORT
1. PICC needs to be maintained at home, PICC supplies, outpatient dressing changes, blood clots more common
2. PORT not maintained while at home, uninsured will usually get a port
Which Chemotherapy requires a cerebellar assessment prior to hanging each chemotherapy bag?
High Dose Cytarabine
Difference between AML and MDS?
Differences of Blasts in the blood stream. AML has greater than 20% blasts in the bloodstream
Hypocalcemia or Hypercalcemia? And what are the symptoms?
Constipation
Fatigue
Muscle Twitching
Increased Thirst
A new AML patient comes with a WBC count in the 100s, potassium of 3.3, Platelets of 8, and a fever. What do you do?
-Hydrea
-Fluids
-Question repletion- they are lysing so chances are as you give Hydrea you may not need to replete electrolytes
-Give platelets. If they need PRBC but have a super high WBC then use caution because of hyperviscosity
-Blood cultures, tylenol, antibiotics
FEVER! What do you do?!?!
1. Blood Cultures
2. Antibiotic
3. Tylenol
4. Urine Culture
5. RVP
6. CT of chest/ Xray
What 5 orders would you expect to see for immediate action for a new AML admission?
1. Labs (Ex: TLS, CBC)
2. Telemetry
3. Blood or Platelets
4. Hydrea
5. Fluids
What do you need to monitor during the LoCoCo regimen?
1. Potassium & Magnesium
2. QTc <500 ms for 3 in a row, then twice weekly
Daratumamab Details
-Collect type and screen prior to infusion
-Collect Hep C tests prior
-Can give through a butterfly needle
Patient has a WBC of 80, Phosphorus level of 5, a potassium of 5.2, and a uric acid of 10. What Medications are you giving?
1. Hydrea
2. Renvela WITH MEALS
3. Hyperkalemia Protocol if symptomatic, lactulose, Neb Treatments, Lokelma
4. Rasburicase (send labs on ICE), if below 8 Allopurinol
5. IV Fluids
You hang your 24 hour high dose methotrexate at 13:30. What time should the 24 hour methotrexate lab be ordered for?
Trick question, it would be a 48-hour methotrexate lab ordered for the time of stopping the chemo bag