| Multiple Myeloma
| Oncological emergencies
- Causes polyuria and dehydration as well as many other effects.
- N-Saline 3-6 L over 24 hours depending on fluid balance and level of calcium and cardiac status
- IV Bisphosphonate e.g. Pamidronate.
- Signs and symptoms of inflammation can be minimal or even absent in the neutropenic patient
- The majority of infections in neutropenic fever manifest solely as bacteraemia.
- Perform full examination + blood and urine cultures + CXR and start broad spectrum antibiotics.
- Discuss with Oncology/Haematology and consult local guidelines.
- Withholding empiric antibiotics from febrile patients with neutropenia is associated with a mortality rate greater than 80%.
- With the use of empiric antibiotics (no organism found and going on best guess), the mortality rate associated with neutropenic fever has fallen to less than 10%.
- Consult local antibiotic policies. These patients can die quickly and expert help should be sought.
- Commonest cause of hyperviscosity syndrome are Waldenstrom's macroglobulinaemia, Multiple myeloma.
- Patients may have visual disturbances, bleeding, and neurologic manifestations e.g. stroke/TIA.
- Plasma exchange via plasmapheresis is the gold standard of treatment
Superior Vena Caval Obstruction
- Usually a complication of malignancy in almost all cases with external compression of the SVC.
- Seen with Lymphoma, thoracic aortic aneurysms, Bronchogenic carcinoma, Mediastinal fibrosis.
- Clinical there is oedema of face and neck, Headache and sensation of fullness, Dilated upper body veins on chest and neck, Progressive breathlessness.
- CXR and CT may confirm a suspicious mass. If malignancy suspected discuss with local oncologists.
- High dose steroids typically dexamethasone are given acutely and Radiotherapy.
- More commonly stenting radiologically is advocated and this also helps non-malignant/fibrotic causes. May need anticoagulation.