Haematology & Oncology

“Over 2 million units of blood are transfused in the UK per year. While blood is transfused routinely within the NHS, it is not without risks. Some risks are potentially extremely dangerous and could even be life threatening.”
— Burett, 2006

BACKGROUND

Cancers as a group of conditions are the most common cause of death in the UK, overtaking heart disease in 2011.

Most causes of death relate to the natural disease progression of the malignancy. However a significant proportion of morbidity and mortality statistics arise from emergency complications (some of which are reversible) of the malignancy or of treatment of the malignancy.

Deaths from neutropenic sepsis for example have doubled since 2001, a malignant pericardial effusion remains the most common cause of cardiac tamponade.

Knowing how to manage and assess patients presenting with oncological emergencies can prevent mortality and morbidity in an already high risk patient group.

Remember: The most serious complications of transfusion (ABO incompatibility) are a result of human error. Between 1 in 6000 and 1 in 20,000 units of blood transfused are transfused to the wrong patient!

Over two million units of blood are transfused in the UK per year. While blood is transfused routinely within the NHS, it is not without risks. Some risks are potentially extremely dangerous and could even be life threatening (Burett 2006).

Worldwide, 1 in 100,000 transfusions performed result in the death of the patient secondary to a haemolytic crisis.

Due to the potential risks of transfusion, it is essential to review local protocols and be aware of the safety netting procedures. It is also important to know red flag symptoms and when to stop a blood transfusion.

Always consider the following diagnoses:
  • Sickle cell crisis
  • Rapid reversal of overcoagulation
  • Neutropenic sepsis
  • Superior vena cava obstruction
  • Tumour lysis syndrome
  • Hypercalcaemia

LEARNING OUTCOMES FROM COMPLETING THE TASKS

  • Recognise and know how to assess oncological emergencies within the Emergency Department

  • Propose a management plan for common oncological emergencies

  • Prescribe blood and blood products and know the common complications and emergencies that arise from a blood transfusion

  • Discuss the physiology behind calcium regulation, and propose a management plan for the abnormalities of calcium homeostasis

Tasks

Complete the following before the face-to-face session:

Task 1: Sickle Cell

Duration: 35 mins

This clinical guideline (published June 2012) offers evidence-based advice on the management of acute painful sickle cell episodes in hospital.

Task 2: Oncological Emergencies

Duration: 25 mins

These videos, produced by the Royal Berkshire and Dundee NHS trusts respectively, are relatively short but provide a good insight into the common oncological emergencies. Click on the screenshots below. The last 2 videos are from youtube and may not open on UHL trust computers but will on any other device.

Task 4: Best case ever

Duration: 7 mins

An interesting case from Canada, not only does it have an oncological relevance but it is also important to recognise that here is a doctor openly sharing something he admits was a mistake and reflecting on how he went into the consultation with a bias. The main podcasts require a free subscription, but the shorter "best case ever" series do not. You may have already found these podcasts through the additional resources on earlier modules, if not some of the others are worth checking out too.

Task 5: Hypercalcaemia

Duration: 40 mins

Excessive calcium can be a potentially life threatening complication of some malignancies and can also be an initial presentation of some malignant conditions. This module is a good clinically based learning resource to help you work through this potentially confusing condition.

Task 6: Mandatory Training (UHL Staff Only)

Duration: 60 mins

This is a mandatory eLearning module on transfusion, it is also very useful for familiarising yourself with local transfusion protocols and policies.

#EM3 Resources

LIGHTNING LEARNING

CASE DISCUSSION

We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.

Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.

Part of the face-to-face teaching will be spent discussing the case(s) below:

“A 46 year old woman with breast cancer presents to the Emergency Department after being advised to attend by the chemotherapy unit...”
“A 33 year old woman presented to the Emergency Department with severe leg pain. The pain is in the lower calf and has begun suddenly one hour ago...”

ADDITIONAL RESOURCES

Here are some extra resources to review if you want more information:

Sketchy Medicine:

This link is to the haematology section which covers:

  • Iron metabolism

  • Haemostatsis

  • Types of WBC

  • The Clotting Cascade

  • Hypersensitivity Reactions

Oncological Emergencies:

An article from the annals of oncology (2004), it is a bit of heavy reading and hopefully a lot of the tasks will have covered much of the content. However for those of you who like to read articles this is a good summary.

DNUK:

Cancer Associated Thrombosis eLearning module covering: pathophysiology, some of the evidence base behind treatments and some of the challenges in managing these patients.

ABC of clinical haematology (BMJ):

This BMJ clinical review covers several emergencies:

  • Hyperviscosity Syndrome

  • Sickle Cell Crisis

  • DIC

  • Infection in Patients with Impaired Immunity

It should be available to BMJ members or through Athens via UHL.

COURSE FEEDBACK

Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form:

Updated: 5th January 2017