or increasing the dose of growth factor although this is the practice at some institutions The literature is inconclusive about the use of WBC transfusions in neutropenic patients with bacteremia, if the neutrophil recovery is expected within the next to 10 days The urgency of the need for platelet transfusion varies with the circumstance In the ED, it may be more expedient to give platelets during a procedure rather than transfusing in advance and rechecking a platelet count prior to the procedure Institutional guidelines should prevail regarding blood type matching, use of anti-D products in males, and prophylactic transfusion criteria In a patient with active lifethreatening bleeding, transfusion should not be delayed to await apheresis platelets If there is severe bleeding in a patient who is refractory to platelet transfusions, the blood bank should be consulted to arrange a continuous infusion of platelets The need for transfusion in the ED varies with the severity of the anemia and clinical circumstances ( Table 98.7 ) Additional information on transfusions in the actively bleeding patient and administration guidelines can be found in Chapter 93 Hematologic Emergencies The oncology-specific history is critical to identify contributing factors The platelet count should always be checked immediately and transfusion given as indicated ( Table 98.7 ) Reversal of any anticoagulation should be considered in a patient with significant bleeding Management of thrombosis is discussed in Chapter 93 Hematologic Emergencies If a central venous sinus thrombosis is suspected, CT scans may not be sensitive enough to secure a diagnosis Addition of intravenous contrast may be helpful, or MRI is generally reliable Once the diagnosis is established, management consists of supportive care and initiation of anticoagulation Of note, for patients on asparaginase receiving anticoagulation for a thrombus, the antithrombin level must be monitored regularly and should generally be replaced with antithrombin III when levels fall below 50% INFECTIOUS COMPLICATIONS OF CANCER TREATMENT Goals of Treatment Oncology patients are at high risk for life-threatening infection, and prompt initiation of volume resuscitation and antibiotic administration is critical to optimal outcome Early administration of empiric broad-spectrum antibiotics can prevent morbidity and mortality in febrile neutropenic oncology patients CLINICAL PEARLS AND PITFALLS