Thông tin tài liệu
lead to life-threatening airway compromise and/or superior vena cava (SVC) syndrome The approach to the presentation and management of AMM is discussed in more detail in the section on thoracic tumors (see “Tumors of the Thorax” section) Chloroma, a mass of leukemic blasts in the soft tissue, can occur in any body part and is much more common with AML compared to ALL When this mass develops and rapidly expands near the spinal cord, compression of the cord can result (see “Tumors in and Around the Spinal Cord” section) Leukemic involvement in the spinal fluid can cause meningeal symptoms, cranial nerve palsy, headache, seizure, increased intracranial pressure (ICP), or visual disturbances (from retinal infiltrates) Boys can present with testicular enlargement There may also be skin lesions due to leukemia cutis (more common in monocytic leukemias and infant leukemia) and gingival hypertrophy (with AML) due to leukemic infiltration It is not uncommon for patients with leukemia to be febrile at presentation Although the fever may be an inflammatory reaction driven by the leukemia itself, serious infection must be explored It is essential to determine if the febrile patient is neutropenic If the absolute neutrophil count (ANC) is less than 500/μL, broadspectrum antibiotics covering gram-positive and gram-negative bacteria (including pseudomonas) should be administered in the ED If localizing signs of a bacterial infection are evident, or if high fevers are present (>39°C), empiric therapy should be initiated even if the patient is not neutropenic Management is summarized in Table 98.3 Patients may present with sepsis at the time of diagnosis or relapse The increased risk of sepsis may be because of neutropenia and/or immune dysfunction caused by the underlying malignancy Management of sepsis in the setting of leukemia is not unique and the principles are similar to those described more thoroughly in the Children’s Hospital of Philadelphia Severe Sepsis Clinical Pathway and Chapter 94 Infectious Disease Emergencies Pain For some patients, limp or a refusal to walk or bear weight is one of the first signs of leukemia In fact, it is not uncommon for a patient to be treated for diagnoses such as osteomyelitis or septic hip before the diagnosis of leukemia is uncovered It is essential for the emergency clinician to ensure that a refusal to walk is not because of cord compression from chloroma as discussed above Bone pain is usually due to replacement of the bone marrow with rapidly proliferating leukemic cells causing strain on the marrow spaces Pathologic fractures may develop as the expanding marrow compartments put strain on and weaken the bony cortex HISTIOCYTIC DISEASES Goal of Treatment
Ngày đăng: 22/10/2022, 13:29
Xem thêm:
