Common leukemia Emergency Treatment

Posted by papapa on July 9, 2008 in Cancer

(A) bleeding leukemia can be bleeding throughout the body parts, the deadly hemorrhagic need for timely treatment.

1, due to acute leukemia with disseminated intravascular coagulation (DIC) caused extensive bleeding or severe acute leukemia cells can release thromboplastin-like substances activate clotting system, a typical DIC, particularly in M3 of the highest rates, followed by the M5 Type, and less in ALL. M3 is characterized by the incidence of acute and more dangerous condition, bleeding tendency can be serious, natural history short, about two weeks, and often died of brain hemorrhage or gastrointestinal bleeding and infection. This type reported in 1957, accounting for 6% of acute leukemia, in the past high fatality rate in recent years, more effective chemotherapy drugs, M3 greatly improved the prognosis, if handled properly and timely treatment, often receive long-term survival. Therefore, when patients with skin was bleeding stasis points, or large Yuban, puncture-prone parts of subcutaneous hemorrhage or hematoma, or bleeding site if the nasal cavity, gums, oral mucosa, with the ball under the membrane, such as retinal bleeding, serious hemoptysis, Blood in the stool, Niaoxue, liver, spleen and lymph node swelling and tenderness sternum was not obvious, especially the peripheral blood emergency check blood smears, and at the same time venous blood coagulation test of time, prothrombin time, 3 P test, fibrinogen half Quantitative, gifted globulin dissolution test, FDP, such as quantitative examination. If the blood smears found that a majority of the abnormal cells as early as David tablets (intracytoplasmic full of thick and deep into thetoluidine blue particles, but sometimes can be as small particles pale yellow), M3 may be more basic set of (need for bone marrow Confirmed, but sometimes smears often dissatisfied with the result of the early high condensate, liquid bone marrow is very easy to solidification). If the clotting time shortened, prothrombin time extension, reduce fibrinogen, 3 P test positive, FDP quantitative increase in a statement that there DIC, should be given heparin in the treatment. Since the leukemia cells procoagulant activity increased in DIC is the cause, not to eliminate these cells not possible to fundamentally resolve, we need early chemotherapy. However, chemotherapy and the destruction of a large number of leukemia cells, often also induce or increase the DIC, it must be chemotherapy and anticoagulant at the same time, heparin in the treatment of 1 to 2 days after the start of chemotherapy at the same time. The current M3-anticoagulation therapy and other causes arising from the DIC somewhat different, that is, the dose of heparin should be more smaller, the general section on the 1st to 50 ~ 100 mg intravenous drip, after 25 ~ 50 mg per day to maintain, 5-7 Days to disable. As for the chemotherapy, a few years ago the domestic use of HO-AP Programme (homoharringtonine, VCR, cytarabine and prednisone), 1987 national conference to discuss the treatment of leukemia, Shanghai Institute of Hematology make use of - Trans retinoic acid-induced differentiation of M3-23 cases, 21 cases were complete remission, and no case in DIC. So, can be HOAP half of the programme or low-dose oral homoharringtonine and retinoic acid solution. As to whether the process of DIC combined fibrinolysis inhibitor will depend on the clinical course (DIC advanced or gifted globulin dissolved less than 90 timesharing use). Such as the tendency of serious bleeding, heparin has been used after chemotherapy or after the commencement of daily or every other day should be lost to the new blood (blood inventories will add to DIC, should not use) added the lack of clotting factor. M3-most are low white blood cell count, should not be delayed chemotherapy.

2. Because of thrombocytopenia or vessel wall damage caused by the infiltration of bleeding

(1) cerebral hemorrhage: often one of the reasons for the leukemia death. Leukemia cerebral hemorrhage before the first regular session of the mucous membrane of skin has been bleeding and anemia, such as history, before the diagnosis may not explicitly deal with general principles, such as keep quiet and avoid moving, oxygen, and so on. After the infusion of a clear diagnosis of enrichment suspension or new blood platelets, intravenous drugs such as the adrenal cortex Dexamethasone 20 mg / d, at the infusion, and every vein 6 ~ 8 h speed drops 20% mannitol 250 ml, aims to reduce brain Edema to prevent cerebral hernia.

(2) gastrointestinal bleeding: As thrombocytopenia or leukemia cells local infiltration may have caused bleeding ulcers. In addition to the new blood transfusion, upper gastrointestinal bleeding gastric tube can be oral or injected saline ice is added to 200 ml adrenaline 8 ~ 10 mg, can also be oral Yunnan Baiyao, March 7 powder, fresh Ouzhi or thrombin, may also try intravenous drip Cimetidine. Lower gastrointestinal bleeding may try acid test of hydrogen 100 ~ 200 mg and 100 ml saline retention enema.

(3) vaginal bleeding: such as excessive menstrual blood, as can be intramuscular testosterone propionate-100 mg, daily one, the linked three to five days, and No. 5 in the menstrual compound 18 a day (of contraceptives) More long-term use, temporarily avoid menstruation Laichao, so as not to add to anemia. As for young women to try to achieve benzophenone estrogen ethanol aim to stop bleeding. Bleeding from the more general uterine bleeding, such as the function of uterine bleeding, but young women should note the exception of abortion, ectopic pregnancy, and so may be. In addition to using a triple drugs (testosterone propionate-, B Di phenol and progesterone), but the leukemia patients undesirable, because there are still bleeding after the withdrawal of bleeding problems, older women can please gynecological consultation, the use of cotton Phenol treatment, to menopause. If the great amount of bleeding, not stop, there should also seek the views of gynecology hysterectomy or uterine packing the indications.

(4) epistaxis: Leukemia is the most common bleeding. Small amount of bleeding, nose ice bag Cold Compress, local oppression can be used to stop bleeding stained with adrenaline, ephedrine, such as vasoconstriction of the gauze packing, or stained with thrombin, Chinese medicine powder gauze packing to stop bleeding. If the large amount of bleeding REQUIRED ear to help doctors before and after the nose, are packing. Note that the stuffing should be at 48 h, by not more than 72 h removed, or easily cause local secondary infection.

(5) bleeding gums: Local ice compress can be used to stop bleeding or oppression (of drugs to stop bleeding), accompanied by 1.5% hydrogen peroxide or cooling blood, gargle decoction of Chinese medicine to stop bleeding.

3. Clotting factor acquired part of the abnormal bleeding has been confirmed to the leukemic in outpatient chemotherapy, patients with advanced high-dose chemotherapy for liver function are sometimes obvious damage, such as the application of advanced ALL L-asparaginase or to large doses of ammonia A Die啶, and other treatment, if a bleeding emergency, they should think of such a possibility. Because of clotting factor in many of the liver, liver damage when a substantive prone bleeding tendency, with vitamin K-dependent clotting factor of the most common obstacles. In addition to chemotherapy should be stopped, should lose fresh plasma, and given intravenous vitamin K and protective treatment.

(B) If fever leukemia patients fever as the first symptom of emergency, if not a detailed investigation of often mistaken for flu; should check for skin and mucous membrane pale and bleeding points, asymmetric exophthalmos (for the green eyes of The good of the site), swollen gums whether the nipple, hyperplasia, easy bleeding, whether oral ulcers, swollen salivary glands and whether the lacrimal gland, there substernal pain, limb bones and joint tenderness there, liver, spleen, lymph nodes whether Such as swelling. For enquiries should be suspicious of whole blood, as only missed easy to check white blood cell count. Main fever and infection, normal immune function and reduce leukocyte reduced due. This was followed by white blood cell proliferation and metabolism of the hyperthyroidism. The beginning of the leukemia did not rule before the early fever, generally easier to control, and after several chemotherapy did not control or disease recurrence and advanced patient’s fever is difficult to control. After repeated chemotherapy for immune dysfunction, to reduce the tablets cells, the lower inflammation, infection and multi-site potential, and often difficult to find clear Gan Ranzao. In particular, patients often go to hospitals for medical treatment, and hospital pathogens and more complex and often resistant strains or fungi, viruses. Leukemia not have long-term fever under control, should be actively looking for the attention of ① Gan Ranzao and pathogens in check, perturbation chest film, blood culture (including anaerobic training), throat swab and sputum culture, sputum and acid-fast bacilli The Pap smear, such as oral examination. ② according to hospital data confirmed the infection by the bacteria, gram-negative bacillus infection was significantly higher than that of gram-positive cocci infections, therefore, was not agreed until the outcome of bacterial culture, including the choice of gram-negative bacillus effective broad-spectrum antibiotics , Or joint targeted antibiotics, and the best by intravenous injection. ③ attention except for fungal infections, can make oral or sputum smears, if found thrush, and suspect and respiratory or gastrointestinal fungal infection, may increase by 5 - fluorocytosine or clotrimazole treatment. ④ if long-term fever and symptoms is still good, did not find clear Gan Ranzao can also try a treatment of anti-TB test period. ⑤ neutrophil significantly reduced, conditional lose tablets when the new cells or blood cell transfusion component (centrifuge to remove plasma precipitation). ⑥ where local Gan Ranzao should have the attention of local processing at the same time, such as oral ulcer infection, perianal infections, soft tissue infections, such as local cleaning can be added, such as topical treatment with Chinese medicine. ⑦ initial treatment or relapse of leukemia with fever and found no clear Gan Ranzao, may be caused by leukemia itself, the anti-infection in chemotherapy at the same time.

(C) anemia and leukemia sometimes bleeding degree of anemia is not parallel, because of anemia due to the suppression of erythropoietin, and shorten the life of red blood cells, generating an increase of invalidity and hemolytic or loss of the extensive bleeding. Early general ANLL than ALL anemia is obvious, especially in M6 type. Yichang chemotherapy for leukemia increase anemia, bone marrow suppression such as chemotherapy-induced anemia more obvious. Severe anaemia and can lead to heart failure induced by the emergency, then promptly lost red blood cells or fresh whole blood, and given diuretics, oxygen inhalation, only to have no cardiac drug benefits. CLL patients in about 20% to 30% of the patients can occur late in their autoimmune hemolytic anemia (anti-human globulin test positive) should be give adrenocortical hormone therapy.
(D) of bone and joint pain large number of leukemia cell proliferation and infiltration periosteal bone can cause limb bone and joint pain, but no local red, swollen, hot phenomenon. This situation more common in ALL, sometimes found at the blast crisis CML. Patients often call, quite disturbed, In such a situation should heighten their vigilance and avoid mistaken for rheumatism. After confirmed to be given potent analgesic and timely given chemotherapy as soon as possible.

(E) of acute renal failure due to acute leukemia chemotherapy destruction of a large number of leukocytes, more blood uric acid increased. If chemotherapy during gastrointestinal reaction weight (vomiting, eating less), dehydration Niaoshao, when the tubular pH lower than 5.5, uric acid in the remote-tubular, the collection of crystal precipitation, causing obstruction of kidney damage, serious Who have acute renal failure. At this point should be rehydration, intravenous sodium bicarbonate to alkaline urine and, if necessary, carry out blood dialysis or peritoneal dialysis.

(6) of the central nervous system of leukemia cells by infiltrating the central nervous system is common, especially in the high incidence of ALL. Central nervous system leukemia can occur in the course of leukemia at any stage, although most cases have occurred in the diagnosis of leukemia, or even often in complete remission after treatment of leukemia, therefore, it is not difficult diagnosis. But there are a small part of (our hospital information about 11.2 percent) are headache, vomiting, cranial nerve palsy, urine retention, and even coma as the first symptom, although in the emergency room when a lumbar puncture, but because of the absence of naive cells in cerebrospinal fluid for examination, Can also be misused to tuberculous meningitis. If careful investigation at this time of patients with anemia have more, such as for inspection of whole blood, as often can be found in time leukemia. Therefore, raising awareness in this regard, to be more vigilant and promptly made the correct diagnosis is not difficult. Meningeal leukemia diagnosed after lumbar puncture, intrathecal methotrexate 10 mg and Dexamethasone 2 mg, but the injection to slow, while injection-repeated aspiration of cerebrospinal fluid and liquid mixing, so as to avoid high concentrations of liquid medicine to stimulate the brain and spinal cord.

(7) other CML patients because of Splenectomy in the diagnosis of individual cases before and after the rupture can occur due to trauma and emergency, time required emergency surgery. Some chemotherapy drugs such as daunorubicin injected into the bloodstream, and even in local swelling and emergency necrosis, or the side effects of chemotherapy drugs, such as bleeding of the bladder Yandeng