Hematology Oncology Cases April 2013

Oncology Case 50 year old male PMHx: HTN, MI – stents, Colon Ca – chemo last week. Unsure about mets.

Oncology Case Scenarios 1. Fever at home >38.5deg. 2. Altered level of conscious without fever 3. Acute shortness of breath 4. Back pain

Transfusion Case 1 65 year old female. Lower GI Bleed but stable. Receiving 2U pRBCs. GI consultant to come and see. Handover patient as she is getting her second unit of blood. Nurse comes to you and says....

Transfusion Case 1 Scenarios 1. “Doc, that patient getting the 2 units of blood, now has a fever of 38.5deg.” 2. “Doc, she is really has having a hard time breathing” 3. “Doc, she is really confused and her BP is 80/40.”

Transfusion Case 2 Working in small ER. MVC from local highway comes in. Your patient has a mid-shaft femur fracture and BP is labile. You start transfusing pRBC and hoping to transfer patient but weather is bad and Ornge is delayed. After the nurse hangs the fifth pRBC, you wonder what might be the issues with massive transfusion? What if the patient is a 5 years old?

Hemolytic Case 1 36 year old male immigrant from Ghana Complaining of fever, abdominal and back pain No travel but two days ago treated for urethritis in clinic with Cipro. OE: T 38.5, BP 110/80, HR 100, Sat 99% Jaundiced. Urine: Hematuria.

Hemolytic Case 2 25 year old male with history of Sickle Cell Disease. Presents to ER with acute chest pain.

Platelet Case 30 year old Male Rash on his legs

Platelet Case Scenarios 1: Confusion but hemodynamically stable 2: Confused and hemodynamically unstable 3: Recent viral illness, otherwise well