Ebook Haematology in critical care: Part 2
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Ebook Haematology in critical care: Part 2
SECTION 5Approach to white Cell ProblemsCHAPTER 20Infectious Complications in theImmunosuppressed PatientTim Collyns1 and Elankumaran Paramasivam2'Lee Ebook Haematology in critical care: Part 2eds Teaching Hospitals Trust. St James's University Hospital. Leeds, UK2St James’s University Hospital. Leeds. UKIntroductionNeutropenic feverPatients with many haematological disorders have an increased susceptibility to infections. This may be due to disruption of the patients host defences by the Ebook Haematology in critical care: Part 2 underlying condition and/or the subsequent haematological treatment. Some examples are listed in Table 20.1; however, the spectrum of infectious diseEbook Haematology in critical care: Part 2
ases which may be involved varies With the type and severity of the haematological condition and the associated therapy 11-3]. It is also related to tSECTION 5Approach to white Cell ProblemsCHAPTER 20Infectious Complications in theImmunosuppressed PatientTim Collyns1 and Elankumaran Paramasivam2'Lee Ebook Haematology in critical care: Part 2he haematological disease, patients may present with more than one infectious complication, either concurrently or consecutively. Patients may require critical care level support due to the systemic sequelae of an infection, or they may acquire certain infections while in the critical care environme Ebook Haematology in critical care: Part 2nt. This chapter outlines some of the more common scenarios in the critical care setting and approaches to their diagnosis and successful management.Ebook Haematology in critical care: Part 2
Infectious complications contribute significantly to the overall morbidity and mortality of haematological diseases; hence, there will usually be locaSECTION 5Approach to white Cell ProblemsCHAPTER 20Infectious Complications in theImmunosuppressed PatientTim Collyns1 and Elankumaran Paramasivam2'Lee Ebook Haematology in critical care: Part 2ses. Standard, internationally applied definitions are available (Table 20.2), but there may be local variation in interpretation of both neutropenia and fever [1. 2, 4], Diagnostic criteria for assessing sepsis severity are also outlined in Table 20.2 [5,6|. The National Institute for Health and Cl Ebook Haematology in critical care: Part 2inical Excellence (NICE) in the UK has recently issued guidance tor the prevention anti management of neutropenic sepsis - in which the criteria for aEbook Haematology in critical care: Part 2
diagnosis of sepsis includes a fever greater than 38°c alone, while neutropenia is defined as the patients neutrophil count being equal to. or less tSECTION 5Approach to white Cell ProblemsCHAPTER 20Infectious Complications in theImmunosuppressed PatientTim Collyns1 and Elankumaran Paramasivam2'Lee Ebook Haematology in critical care: Part 2d with disruption of skin and mucosal barriers, predispose the patient to infection. The risk is inversely proportional to the absolute count, and 10-20% of patients with a neutrophil count less than 0.1 X 1071. will have a bloodstream infection. Fever is an early, albeit non-specific, sign of infec Ebook Haematology in critical care: Part 2tion, although classic symptoms and signs may be reduced or absent 11, 2). Only 20-30% of neutropenic fevers are due to clinically identified infectioEbook Haematology in critical care: Part 2
n |2).The aetiology of likely infecting organisms varies with length of neutropenia, previous or current antimicrobialHaematology in Critical Cdnr A PSECTION 5Approach to white Cell ProblemsCHAPTER 20Infectious Complications in theImmunosuppressed PatientTim Collyns1 and Elankumaran Paramasivam2'Lee Ebook Haematology in critical care: Part 2.125O'Table 20.1 Some specific infections associated 7.1th, and/or more severe in. specific conditions [1 -31NeutropeniaVira; infections HSV reactivation Bactenal infections (see aso TdJe 20.3) Gut translocation Eniembacteriaceae (ccAfcnms) bne associated staphylococci Fungal infections CarxAda spec Ebook Haematology in critical care: Part 2ies Aspergiffus speces, most common Aspergillus ftxn>gatus (othe' moulds)Hypogammaglobu •'aemidmpared humorđ immunityEncapsulated bactena; principallyEbook Haematology in critical care: Part 2
Streptococcus pnewmortae, aso HaemopMus influenzae, Neisseria men/rýtiơis Sincpulmonary infections, 4/- septicaemiaLympnopemaAmpared cellular immunitSECTION 5Approach to white Cell ProblemsCHAPTER 20Infectious Complications in theImmunosuppressed PatientTim Collyns1 and Elankumaran Paramasivam2'Lee Ebook Haematology in critical care: Part 2pecies, p. jirovecv faroptosma good" reactivationAspleniơíu^cticna y hyposplemcEncapsulated bactena. principally s. pneumoniae, also H. influenzae, Capnocytophaga spp„ parasite infections. malaria, babesiosisAcute leukaemiasIf neutropenic, see preceding text. Patients with acute mydoĩd leukaemia (AM Ebook Haematology in critical care: Part 2L) O' myelodysplastic Syndrome (MOS) ma/ be functionally neutropenic. I.e. detectable but ineffective neutrophils Acute lymphocytic ’eukaerrra (ALL):Ebook Haematology in critical care: Part 2
PrwumocysDsCh'cnic lymphocyte leukaemia (CIDHypogammaglobu raemk - see preceding text CLL treatment (eg demtuzumab. MabCampath®): wide range, includinSECTION 5Approach to white Cell ProblemsCHAPTER 20Infectious Complications in theImmunosuppressed PatientTim Collyns1 and Elankumaran Paramasivam2'Lee Ebook Haematology in critical care: Part 2diseaseFunctional hyposplenic - see preceding text Salmonella osteomyelitisIron overload le.g. thdassaemias) and/or iron chelator therapy such as desferrioxamineWsmia spp. other bacteria ma/ ha.e increased pathogenicity in presence of iron-rich mheu fungal infection (Zygomycetes)Haemopoeúc stem cdl Ebook Haematology in critical care: Part 2t'ansplant (HSCT) reòpientsRelative risks vary ccnsideratly w.th scurce/type of transplant and co"ditioning regime, as well as trderljwvg disease anaEbook Haematology in critical care: Part 2
previous t'eatment. Alogeneic recioents are mere IGọi ngay
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