CHEMOTHERAPY-RELATED EMERGENCIES

With administration of most chemotherapeutic drugs, granulocytopenia and thrombocytopenia regularly occur. Although granulocytopenia itself does not necessitate hospitalization, infection, characterized by fever, chills, or specific signs and symptoms, indicates a need for immediate antibiotic therapy, usually as an inpatient, if the patient has neutropenia. Blood, urine, and other fluids are cultured, and broad-spectrum, antipseudomonal antibiotics are started immediately and empirically. Administration of antibiotics is continued until neutropenia, fever, and infection resolve. Administration of granulocyte colony-stimulating factor has a role in preventing infection among aggressively treated patients but is not as helpful if initiated in the setting of established neutropenic fever.

Thrombocytopenia can be life-threatening, particularly if platelet counts decrease to less than 10,000/L to 20,000/L, in which case spontaneous and fatal hemorrhage can occur. The patient is treated with platelet transfusions until the platelet count returns to a safe range. These patients may need hospitalization because of bleeding or, in some instances, for transfusions of platelets.

Acute renal failure can occur with administration of drugs such as high-dose methotrexate or cisplatin. Patients receiving cisplatin can have severe electrolyte wasting. These conditions necessitate in-hospital evaluation and treatment by a medical oncologist and nephrologist. Allergic reactions, especially to paclitaxel, bleomycin, or cetuximab, can be severe and necessitate treatment with antihistamines, steroids, and other support. Leakage or extravasation of drugs such as vincristine or doxorubicincan cause necrosis of the skin and necessitate immediate treatment.