Neutropenic enterocolitis

Bavaro, Mary

doi:10.1007/s11894-002-0079-y

Cited by 49 publications

(18 citation statements)

References 27 publications

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“…This is attributable to chemotherapy and neutropenia leading to intestinal dysfunction and microbial invasion with, secondarily, edema, inflammation, ulceration, transmural necrosis, and possible perforation. 81,84 Abdominal CT (Figure 3) or ultrasound (US) discloses thickening of the bowel wall and intramural edema, which may be accompanied by paracolonic fluid, free air, or pneumatosis intestinalis. A more than or equal to 10-mm wall thickening was associated with 60% mortality compared with 4.2% with less thickening.…”

Section: Can Neutropenic Enterocolitis Be Prevented? Should This Inflmentioning

confidence: 99%

How I treat hematologic emergencies in adults with acute leukemia

Zuckerman

Ganzel

Tallman

et al. 2012

Blood

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Acute myeloid leukemia and acute lymphoblastic leukemia remain devastating diseases. Only approximately 40% of younger and 10% of older adults are long-term survivors. Although curing the leukemia is always the most formidable challenge, complications from the disease itself and its treatment are associated with significant morbidity and mortality. Such complications, discussed herein, include tumor lysis, hyperleukocytosis, cytarabine-induced cellebellar toxicity, acute promyelocytic leukemia differentiation syndrome, thrombohemorrhagic syndrome in acute promyelocytic leukemia, L-asparaginase-associated thrombosis, leukemic meningitis, neutropenic fever, neutropenic enterocolitis, and transfussion-associated GVHD. IntroductionAlthough inadequate for the cure of most patients, the initial therapeutic approach to acute myeloid leukemia (AML) is standardized. However, the management of hematologic emergencies is challenging and may be controversial. We present clinical vignettes describing 10 emergencies encountered in practice and the questions such emergencies generate. We then provide our view of how to treat adults supported by studies if available and, if not, by clinical experience and consensus. The approach to these emergencies is as important as the antileukemia therapy, and in no clinical setting is it fairer to say that "the devil is in the details." Tumor lysis syndromeA 23-year-old man with a history of G6PD deficiency is diagnosed with pre-B acute lymphoblastic leukemia (B-ALL). At presentation, his white blood cell count (WBC) is 160 000/L with 90% lymphoblasts and 450/L neutrophils; the hemoglobin is 7.5 g/dL and platelet count is 10 000/L. His electrolytes and renal function are normal, the uric acid is 11.0 mg/dL, and lactate dehydrogenase (LDH) is 1500 IU/L (normal, 100-250 IU/L). Remission induction chemotherapy is planned. Questions What is the risk of tumor lysis syndrome (TLS)? What is the optimal treatment for preventing TLS? What is the role of rasburicase and urine alkalinization?TLS can appear before starting treatment (primary TLS) as a result of high turnover of the malignant cells or, more commonly, a short time after the beginning of treatment (secondary TLS). 1 The risk of developing TLS and its severity is influenced by many factors, including tumor burden, potential for rapid cell lysis, and preexisting nephropathy. 2 In acute leukemias, the risk is dependent on the WBC and the rate of response to therapy. In ALL with WBC Ͼ 100 000/L, the risk for TLS is high. With lower WBC, the risk is moderate and low. 3 A classification system has been developed, 4 which is based on separate definitions for laboratory and clinical TLS. Laboratory TLS loosely is defined as the presence of 2 or more abnormal laboratory values of uric acid, potassium, phosphorus, or calcium at presentation or a 25% change in values from the pretreatment measurements. Clinical TLS is defined as the presence of laboratory TLS plus renal dysfunction, seizures, cardiac arrhythmia, or sudden death. An expert TLS pane...

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Section: Can Neutropenic Enterocolitis Be Prevented? Should This Inflmentioning

confidence: 99%

How I treat hematologic emergencies in adults with acute leukemia

Zuckerman

Ganzel

Tallman

et al. 2012

Blood

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“…The addition of neutropenia to these two findings supports the typhlitis diagnosis. Typhlitis is encountered in increasing frequency, due to agressive chemotherapy applications [1][2][3]. McCarville et al [4] stated that the patients 16 years or older are more exposed to risk than the younger ones.…”

Section: Discussionmentioning

confidence: 99%

“…In cases with malignancy, typhlitis causes ulceration, necrosis, perforation in intestinal segment by causing the destructive lesion of ileocecal area [1]. Although it is often related to leukemia and lymphoma, it also seen in patients with solid tumor, multiple myeloma, aplastic anemia, AIDS and cyclic neutropenia [1,2]. Being rarely observed in adults, these days typhlitis is encountered in increasing frequency, due to agressive chemotherapy applications [3].…”

Section: Introductionmentioning

confidence: 99%

“Typhlitis” A Rare Diagnose For Emergency Room; Case Report

Güllüpınar¹

2015

Ann Clin Anal Med

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ÖzetTiflitis, çıkan kolon ve çekumun nekroz ve perforasyonu ile karakterize akut bir tablodur. Sıklıkla lösemi ve lenfoma ile ilişkili görülür. Maligniteli bir hastada, nötrope-ni, ateş, sağ alt kadranda ağrı ve hassasiyet mevcutsa ilk akla gelmesi gereken tiflitisdir. Tiflitis tanısında batın bilgisayarlı tomografisi kullanılır. Tiflitis yüksek dü-zeyde mortalite ve morbiditeyle ilişkilidir. Tiflitisin tedavisi medikal veya komplikasyonlara göre cerrahi tedavidir. Erken tanı konulmalı ve tedaviye başlanılmalı-dır. Yazımızda, acil servislerde nadir görülen bir onkolojik acil olan "Tiflitis" olgusunu sunup, tanı ve tedavi yöntemlerini literatür bilgileri eşliğinde gözden geçirdik. Anahtar KelimelerNötropeni; Karın Ağrısı; Ateş; Enterokolit; Malignite AbstractTyphlitis is an acute table that is characterised by the necrosis and perforation of the ascendant colon and cecum. It is often observed to be related to leukemia and lymphoma. If neutropenia, fever, pain in lower right quadrant and sensibility is present in a patient with malignancy, the first thing to think about is typhlitis. Abdominal computed tomography is used in the diagnosis of typhlitis.Typhlitis is related to high mortality and morbidity.The theraphy for typhlitis is medical or, depending on the complications, surgical. Diagnosis should be early and therapy should be started immediately. In our paper, we have presented the "typhlitis" case, which is an oncological emergency that is rarely observed in emergency services, and examined the diagnosis and therapy methods in the light of the relevant literature.

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“…supposed neutropenic colitis), abdominal CT scan [36][37][38]. Dependent on further symptoms, additional imaging (e.g.…”

Section: Empiric Antimicrobial Therapy In Fuomentioning

confidence: 99%