Intervention | Indications |
Oxygen | Hypoxia and/or respiratory distress that might indicate severe anaemia, infection, leucostasis within the lung vasculature or a mediastinal mass. |
Antibiotics | Broad-spectrum antibiotics following local guidelines for neutropaenic sepsis should be started if there are any concerns regarding infection irrespective of neutrophil count. |
Analgesia | Paracetamol±oral morphine. Non-steroidal anti-inflammatory drugs are best avoided in thrombocytopaenia. |
Hyperhydration | For 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 products | Platelets, 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.