Onco!

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Onco!

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04/10/07 - 01:16 PM

62 year old woman with ovarian cancer came to the ED with fever of 2 days. She recieved chemotheraphy with paclitaxel and carboplatin. She feels tired but no nausae and vomitting. Vital signs BP- 100/60 , PR- 115/min , T- 39.5. Hematocrit 32%, wbc 800/mm3, platelet- 105,000. Which of the following is the most apprpriate next step in the management?

a. plasamapheresis
b. additional chemotheraphy
c. iv antibiotics
d. iv corticosteroids
e. transfuse 2u of wbc
f. transfuse 2 u of prbc

Justice
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04/10/07 - 02:07 PM

CT-induced leukopenia - wbc 800/mm3; probably superimposed infection (fever);
(e). transfuse 2u of wbc
rbc and platelets can wait

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doc_clotaire
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04/10/07 - 02:44 PM

This is febrile neutropenia

NSIM ------------------------ C ( IV antibiotics )

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Justice
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04/10/07 - 03:09 PM

doc_clotaire wrote:
This is febrile neutropenia

NSIM ------------------------ C ( IV antibiotics )

Man, you are right!!! How could I miss it???

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cookie909
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04/12/07 - 02:03 PM

can either doc_clotaire or justice explain pls?

doc_clotaire
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04/12/07 - 02:35 PM

The patient had ovarian cancer and she is being treated with chemotherapy ( paclitaxel and carboplantin ) whitch may supress the bone marrow and lead to neutropenia -induced fever . In fact , any patient under chemotherapy for any cancer who develops fever , we must look for FEBRILE NEUTROPENIA because it is that common .

The nest step in management should be empiric broad spectrum antibiotic ( like vancomycin + ceftazidime or ciprofloxacin , imipenem ect.......) because if untreated , these infections may be fatal .

That 's my point of view !

Please , any more input is WELCOME

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