Table 2

Management points to consider

InterventionIndications
OxygenHypoxia and/or respiratory distress that might indicate severe anaemia, infection, leucostasis within the lung vasculature or a mediastinal mass.
AntibioticsBroad-spectrum antibiotics following local guidelines for neutropaenic sepsis should be started if there are any concerns regarding infection irrespective of neutrophil count.
AnalgesiaParacetamol±oral morphine. Non-steroidal anti-inflammatory drugs are best avoided in thrombocytopaenia.
HyperhydrationFor prevention of tumour lysis syndrome following discussion with the PTC. However, transfer to the PTC should not be delayed if there is difficulty in obtaining these drugs.
Allopurinol or rasburicase
Blood productsPlatelets, fresh frozen plasma and/or cryoprecipitate transfusion may be required to treat bleeding. Red cell transfusion should be considered carefully particularly in the context of a high or rising white cell count because the further increase in viscosity from packed red cell transfusion can precipitate complications of hyperleucostasis.
  • PTC, primary treatment centre.