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Neutropenic Fever During Chemotherapy and Cancer Treatment Emergencies

Xexlẽme kpatawo toa vovo le dukɔ ɖesiaɖe me. Axa sia zã 911, si nye xexlẽdzesi na United States kple Canada. Dukɔ bubu geɖewo zãa 112, 999, alo xexlẽdzesi bubu. Di xexlẽdzesi si le miaƒe dukɔa me.

For anyone receiving chemotherapy, targeted bone marrow therapy, or a stem cell transplant, a simple fever is never "just a cold": it is a life-threatening medical emergency called Febrile Neutropenia (Neutropenic Fever). Chemotherapy destroys rapidly dividing white blood cells known as neutrophils, the body's frontline infantry against bacteria and fungi, especially during the "nadir" window (\(7\text{ to }14\text{ days}\) after a chemotherapy infusion). When neutrophil counts drop to zero or near-zero, harmless bacteria living naturally in the mouth, intestines, or on the skin around a central venous port can invade the bloodstream and double every 20 minutes without producing pus, redness, or coughing. Left untreated at home for even a few hours, neutropenic fever rapidly progresses to fulminant sepsis and septic shock. Survival depends on the Golden Hour "Door-to-Antibiotic" Rule: reaching an emergency department immediately so intravenous broad-spectrum antibiotics are infusing within 60 minutes of triage, and never masking a rising fever with over-the-counter acetaminophen (paracetamol) or ibuprofen before calling the oncology team.

Never take Tylenol (acetaminophen), paracetamol, ibuprofen, or aspirin before calling your oncologist

Because a chemotherapy patient with low white blood cells (neutropenia) cannot form pus or localized inflammation, fever is often the ONLY warning sign in the entire body that a lethal bacterial bloodstream infection has begun. Swallowing acetaminophen (paracetamol), ibuprofen, naproxen, or aspirin to "bring the fever down and go back to sleep" artificially hides the fever for 4 to 6 hours while bacteria multiply unchecked in the bloodstream, leading to irreversible septic shock. Also, never insert a rectal thermometer, rectal suppository, or enema in a chemotherapy patient: tearing the fragile rectal lining pushes gut bacteria directly into the blood and can cause uncontrollable rectal hemorrhage if platelets are low.

Wɔ esia fifia

  1. Check an oral (mouth) or tympanic/temporal temperature immediately and apply the strict \(38.3^\circ\text{C}\) (\(101.0^\circ\text{F}\)) / \(38.0^\circ\text{C}\) (\(100.4^\circ\text{F}\)) rule. According to the Infectious Diseases Society of America (IDSA), American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), and UK NICE guidelines, Neutropenic Fever is defined as:
  2. A single oral temperature of \(38.3^\circ\text{C}\) (\(101.0^\circ\text{F}\)) or higher, OR
  3. An oral temperature of \(38.0^\circ\text{C}\) (\(100.4^\circ\text{F}\)) or higher that persists for 1 hour (or is measured twice at least 1 hour apart).
  4. (Note: Many UK NHS trusts and cancer centers use an even stricter single-reading threshold of \(38.0^\circ\text{C}\) [\(100.4^\circ\text{F}\)] once, or \(37.5^\circ\text{C}\) [\(99.5^\circ\text{F}\)] twice 1 hour apart; always follow your cancer center's strictest card threshold.)
  5. Ƒo ka na wò nutoa me ƒe xexlẽdzesi kpata enumake ne dɔnɔa ƒe lãme vuvu/sesẽ, taɖuame, tɔtɔ, gbɔgbɔtsixe tsi ƒo, alo ʋu ƒe sisi le eŋu. Ƒo ka na 911 le United States kple Canada, 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 999 le United Kingdom, alo kpɔ wo katã xexlẽdzesi siwo wozãna kpata ne dɔnɔa ƒe vuvɔ ʋuʋu (sesẽ), se le eɖokui me be yeƒe lãme gbɔdzɔ ne ele tsitre, eƒe dzi ƒe tsotso kabakaba (\(>100\text{ bpm}\)), ʋu ƒe sisi le ʋuka me le esi mede \(100\text{ mmHg}\) o, alo eƒe dzedzeme le ɣie, flitete, alo tɔtɔ, ne woƒe dzoxɔxɔdzidzenu xlẽ be esɔ alo bɔbɔ le mɔ si mesɔ o nu (\(<36.0^\circ\text{C}\)) gɔ̃ hã alo \(<96.8^\circ\text{F}\)), elabena vuvɔ me dɔlékuiwutikewoe nye septic shock ƒomevi si me afɔku le wu.
  6. Ne asrã li ke la, ƒo ka na wò Oncology Triage Line si wɔa dɔ gaƒoƒo 24 enumake eye nàyi Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ tẽ. Mègalala vaseɖe ŋdi ƒe ɔfis gaƒoƒo o. Na ame aɖe naku dɔnɔa ayi kɔdzi enumake, eye nàbia tso kansadɔdala si le dɔ wɔm na ame si be wòaƒo ka do ŋgɔ na xɔ si me wokpɔa dɔnɔwo gbɔ le kpata ƒe dodokpɔwɔƒe ale be ʋu ƒe dekɔnuwo kple dɔlékuiwutike siwo wodona ɖe ʋuka me nanɔ klalo ne eva ɖo.
  7. MÈGANA atikekui aɖeke si ɖea dzoxɔxɔ dzi kpɔtɔna o (acetaminophen, paracetamol, ibuprofen, alo aspirin mègazã o) eye mèzã dzoxɔxɔdzidzenu si wotsɔna dzidzea dɔgbo me gbeɖe o. Dzidze dzoxɔxɔ le aɖe te (nu me) alo abɔ te (axillary;de dzesii be akɔta ƒe nuxexlẽwo anɔ abe \(0.5^\circ\text{C}\) ene [\(0.9^\circ\text{F}\)] bɔbɔ wu nuxexlẽ siwo wogblɔ kple nu, eyata abɔta nuxexlẽ si nye \(37.8^\circ\text{C}\) [\(100.0^\circ\text{F}\)] sɔ kple nu me dzoxɔxɔ).
  8. De amekoko alo N95/FFP2 gbɔgbɔtsixe ƒe ametakpɔnu si sɔ nyuie na dɔnɔa hafi nàzɔ ayi Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ ƒe lalaƒe. Esi wònye be dɔlélenutsiŋutete ƒe ametakpɔnu aɖeke mele dɔnɔ si ŋu neutropenic mele o kloe ta la, afɔku le dɔnɔ siwo le kɔdzi ƒe xɔ si me amewo sɔ gbɔ ɖo si me ametakpɔnu manɔ o me. Tsɔ wò "Chemotherapy Neutropenic Sepsis Alert Card" na triage dɔnɔdzikpɔla enumake eye nàbia be woatsɔ ye ade dodokpɔxɔ si sa ɖe aga me enumake.
  9. Kpɔ Dɔdzẽ ƒe Nɔnɔme Kpata Ene bubuawo ɖa. Ne èle dzadzram ɖo ɖe ʋuɖoɖo ŋu la, doe kpɔ kaba be Malignant Spinal Cord Compression (akɔtave yeye si me afɔ ƒe gbɔdzɔgbɔdzɔ, lãmetutudɔ, alo tsinyegoe ƒe kuxi le), Superior Vena Cava (SVC) Syndrome (mo/kɔ vuvu kple gbɔgbɔtsixetsixe), Tumor Lysis Syndrome (lãmekawo ƒe ʋuʋu, aɖuɖɔ si do viviti/mele o, dzi ƒe tsotso le ŋkeke aɖewo megbe tso esime wodze chemo gɔme), kple Hypercalcemia of Malignancy (tsikɔwuame si gbɔ eme, aɖuɖɔtoe enuenu, dɔmeɖui, kple tɔtɔ).

Kpata ƒe vovototodedeameme kple kansa dada ƒe kuxi ŋuti nyametsotsoti

Zã dɔdamɔnu ƒe ɖoɖowɔɖi sia nàtsɔ atso dzesi ɖesiaɖe si nu sẽ le dɔnɔ si le kansa ƒe dɔdamɔnu si le dɔ wɔm alo le kwasiɖa 6 me le atikewɔmɔnu zazã vɔ megbe.

flowchart TD
    Start["Kansa Dɔnɔ si le Atikewɔmɔnu, Dɔlélenutsiŋutete ƒe Dɔdamɔnu,<br/>alo Kekeli ƒe Dɔdamɔnu zãm la Vaa Dzesi Kpuiewo"] --> SepsisFlags{"Afɔɖeɖe 1: Kpɔ Septic Shock / Crisis Red Flags Enumake ɖa<br/>1. Vuvɔ ʋuʋu (sesẽ), ne dzoxɔxɔ gã aɖeke mele eŋu o gɔ̃ hã?<br/>2. Dzoxɔxɔ si nu sẽ: Dzoxɔxɔ < 36.0°C (96.8°F)?<br/>3. Taɖuame, alɔ̃madɔmadɔ, tɔtɔ, alo nuƒoƒo si me mekɔ o?<br/>4. Gbɔgbɔ kpuie, gbɔgbɔ kabakaba, alo akɔtavea?<br/>5. Dzĩ, ʋuʋudedi, alo vevesese le Port-a-Cath / PICC / Hickman fli dzia?"}

    SepsisFlags -->|"Ẽ: Ame 1 ɖesiaɖe si le afima"| Call911["DƆDASI ƑE ƲUƲU VEVIETƆ / XEXLẼME:<br/>1. Ƒo ka na 911 / 112 / 999 Enumake na Ambulance<br/>2. Ðe gbeƒãe be ‘Atikewɔwɔ ƒe Neutropenic Sepsis Emergency’<br/>3. Wɔ Aɖabaƒoƒo 60 ƒe Ʋɔtru Yi IV-Dɔlékuiwutike ƒe Taɖodzinu<br/>4. Yi edzi nàmlɔ anyi (alo nànɔ tsitrenu ne gbɔgbɔtsixe tsi ƒowò); NPO ƒe ŋkɔ"]

    SepsisFlags -->|"AO"| TempCheck{"Afɔɖeɖe 2: Kpɔ Nu me ƒe Dzoxɔxɔ ɖa<br/>(MÈGAZã dzoxɔxɔdzidzenu si le dɔgboa me GBEÐE o)<br/>Ðe temp >= 38.3°C (101.0°F) ZI ÐEKA<br/>ALOO >= 38.0°C (100.4°F) hena gaƒoƒo 1?"}

    TempCheck -->|"Ẽ: Asrã ƒe dzidzenu ɖo"| NeutFever["NEUTROPENIC FEVER ƑE NYA KPƆKPƆ:<br/>1. MÈGANA Tylenol/paracetamol, ibuprofen, alo aspirin<br/>2 o. Ƒo ka na Oncology Triage Line si wɔa dɔ gaƒoƒo 24 FIFIA esime nèle dzodzom<br/>3. Do ametakpɔnu ɖe ​​dɔnɔa ŋu; yi Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ FIFIA<br/>4. Fia Chemo Alert Card le triage me: bia be woaɖe ame ɖe aga +<br/> Ʋu ƒe Dekɔnuwo (Port + Peripheral) & IV Antibiotics < 60 mins"]

    TempCheck -->|"AO: Dzoxɔxɔ alo dɔlékuiwutike ƒe dzesi aɖeke mele eŋu o"| OncEmerg{"Afɔɖeɖe 3: Kpɔ Structural & Metabolic Cancer ƒe Nɔnɔme Kpatawo ɖa:<br/>A. Akɔta/kɔve yeye + afɔ ƒe gbɔdzɔgbɔdzɔ, lãmetutudɔ, alo tsinyegoe ƒe tɔtrɔ?<br/>B. Mo/kɔ/abɔ siwo vuvu + kɔdzi/gbɔgbɔtsixe vɔ̃ɖi wu ne mlɔ anyi?<br/>C. Chemo nyitsɔ laa (ŋkeke 1-7) + ʋuʋudedi, ʋuʋudedi, aɖuɖɔ doviviti?<br/>D. Tsikɔwuame si gbɔ eme, tɔtɔ, dɔmeɖui, ƒu ƒe vevesesea?"}

    OncEmerg -->|"A: Akɔtave + ahɔhɔ̃mekawo ƒe dzesiwo"| MSCC["WOBU BE WOBU BE WOAÐE AKPAÐEKA ƑE ƲUƲU GBƆGBƆ:<br/>Akɔta ƒe MRI Kpata + Dexamethasone si Wozãna le IV me FIFIA"]

    OncEmerg -->|"B: Mo/kɔ ƒe vuvu + gbɔgbɔtsixetsixe"| SVCS["WOBU BE SUPERIOR VENA CAVA (SVC) SYNDROME:<br/>Nɔ anyi ɖe tsitrenu (45-90 deg); Akɔta ƒe CT Kpata + Dɔdzẽ Ŋuti Dɔlélewo Dzikpɔkpɔ"]

    OncEmerg -->|"C alo D: Lãmetsiŋusẽ ƒe kuxi"| Metabolic["WOBU BE ƲUƲU ƑE LYSIS ALOO HYPERCALCEMIA:<br/>Kpata Dɔwɔƒe FIFIA na ECG, Electrolytes, & IV Fluids"]

Akpa 1: Neutropenic Fever kple "Nadir" Afɔku Fesre Gɔmesese

1. Nukae Nye "Absolute Neutrophil Count" (ANC) kple Chemo Nadir?

Ʋumenugbagbevi ɣiwo (leukocytes) lɔ lãmenugbagbevi ƒomevi vovovowo ɖe eme, gake neutrophils ye nye lãmenugbagbevi vevitɔ siwo wua dɔlékuiwo. Ðɔktawo bua akɔnta le Absolute Neutrophil Count (ANC) ŋu to ʋumenugbagbevi ɣiwo ƒe xexlẽme bliboa dzidzi ɖe edzi kple neutrophil siwo woma ɖe akpa vovovowo me ("segs") kple ƒuƒoƒo siwo metsi o ƒe alafa memamã: - Normal Healthy ANC: \(1,500\text{ va ɖo }8,000\text{ lãmenugbagbeviwo le microlitre ɖeka me }(\mu\text{L})\) (alo \(1.5\text{ vaseɖe }8.0 \times 10^9/\text{L}\)). - Neutropenia: ANC le ete ** $ 1,500 nuŋɔŋlɔ { lãmenugbagbeviwo} / mu nuŋɔŋlɔ {L} $ ** ($ < 1.5 zi gbɔ zi 10 ^ 9 / nuŋɔŋlɔ { L} \(). - **Neutropenia Sesẽ (Afɔku Gã le Dzoxɔxɔ):** ANC si le **\)500\text{ cells}/\mu\text{L}\(** (\)<0.5 \times 10^9/\text{L}$), alo Below \(1,000\text{ cells}/\mu\text{L}\) si wokpɔ mɔ be aɖiɖi va anyi wu \(500\) le gaƒoƒo 48 siwo gbɔna me. - Profound Neutropenia (Extreme Risk): ANC below \(100\text{ cells}/\mu\text{L}\) (\(<0.1 \times 10^9/\text{L}\)), common during acute leukemia induction or stem cell transplantation.

When does the "Nadir" occur? After a standard intravenous chemotherapy cycle is infused on Day 1, the neutrophils already circulating in the blood live for a few days while the bone marrow factory is temporarily stunned. Consequently, the white blood cell count hits its lowest rock-bottom point (the nadir) typically between Day 7 and Day 14 after chemotherapy (though it can occur anytime during daily oral targeted therapies, radiation, or hematologic cancers like leukemia, lymphoma, and multiple myeloma).

2. Why Infections Look Completely Invisible When You Have Zero Neutrophils

In a person with a normal immune system, an infection is obvious because millions of neutrophils rush to the site and die, creating thick yellow pus, red swollen skin, painful throat exudates, or dense white patches on a chest X-ray: - No Neutrophils = No Pus and No Classic Symptoms: In a severely neutropenic patient: - A lethal bacterial pneumonia may cause zero cough, zero phlegm, and a completely clear chest X-ray, showing only a fever and slightly fast breathing. - A severe urinary tract infection (urosepsis) may cause zero burning when urinating and show zero white blood cells (pyuria) on a urine dipstick, presenting only with a fever. - A deadly skin or perirectal cellulitis around the anus or a central venous port may show zero pus or fluctuant abscess, presenting only with subtle warmth, faint pinkness, or localized tenderness alongside a fever. - Warning on Corticosteroids Masking the Fever: Many cancer patients take daily or weekly dexamethasone or prednisone (for brain swelling, lymphoma, multiple myeloma, immunotherapy side effects, or nausea). Corticosteroids powerfully suppress the brain's hypothalamus thermostat. A patient taking dexamethasone can have full-blown neutropenic bloodstream sepsis with a normal temperature of \(37.0^\circ\text{C}\) (\(98.6^\circ\text{F}\)). In patients on steroids, watch instead for shaking chills (rigors), sudden exhaustion, mild confusion, dizziness, fast heart rate, or a temperature drop below \(36.0^\circ\text{C}\) (\(96.8^\circ\text{F}\)).

3. The "60-Minute Door-to-Needle Antibiotic Rule"

Once bacteria enter the bloodstream of a patient with no neutrophils (frequently Gram-negative rods like Escherichia coli, Klebsiella pneumoniae, or Pseudomonas aeruginosa translocating across chemotherapy-damaged mouth ulcers [mucositis] or intestinal lining, or Gram-positive cocci like Staphylococcus and Streptococcus from central venous catheters), mortality rises steeply with every hour of delay. - Dukɔwo Dome Kɔdzi ƒe Sedede: Mɔfiame siwo tso ASCO, IDSA, ESMO, Surviving Sepsis Campaign, kple UK NICE (CG151) de se be dɔwɔƒe ɖesiaɖe si kpɔa nudzɔdzɔ kpatawo gbɔ natsɔ empiric anti-pseudomonal intravenous beta-lactam antibiotic (abe cefepime, piperacillin-tazobactam ene) ƒe agbɔsɔsɔme gbãtɔ ana [Zosyn/Tazocin], alo meropenem) le aɖabaƒoƒo 60 me tso esime dɔnɔa to kɔdzi ƒe ʋɔtru nu, malala be ʋumenugbagbevi ɣiwo ƒe xexlẽme (CBC) ƒe dodokpɔ le dodokpɔxɔ me natrɔ ava ne wosusu be ʋumenugbagbeviɣidɔ le eŋu. - Nusi dzɔna le miniti 60 gbãtɔ mawo me: Dɔnɔdzikpɔlawo ɖea ʋu ƒe dekɔnu eve enumake (woɖea ƒuƒoƒo ɖeka to dɔnɔa ƒe Port-a-Cath, PICC line, alo Hickman catheter si wòde la ƒe lumen ɖesiaɖe me, kple hatsotso ɖeka si woɖe tso alɔnu ƒe ʋuka si le gota me), woɖea Complete Blood Count (CBC with differential), metabolic panel, kple ʋu lactate level, eye nàhe dɔlékuiwutike si wodona ɖe ʋuka me la ɖe ati ŋu le ʋuɖeɖe vɔ megbe teti. - High-Risk vs. Low-Risk Triage (The MASCC Score): Ne dɔlékuiwutike si wozãna le IV me ƒe agbɔsɔsɔme le dɔ wɔm ko la, kansadɔdalawo kple atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ bua akɔnta le Multinational Association for Supportive Care in Cancer (MASCC) Risk Index kple CISNE score be woakpɔe ɖa be ele be dɔnɔa nanɔ dɔnɔdzikpɔƒe si woɖea wo ɖe aga le dɔnɔdzikpɔƒe (si nye ʋumenugbagbeviɣidɔ, stem cell hã amedodo na ame, ʋu ƒe sisi, aklãdɔ, ƒodo ƒe vevesese, tɔtɔ, alo ʋumenugbagbeviɣidɔ sesẽ) alo ate ŋu atrɔ ayi atikewɔwɔ si ŋu woléa ŋku ɖo nyuie gbɔ.

Akpa 2: Dzesidede Dɔdzẽ ƒe Nɔnɔme Kpata Atɔ̃ Bubu Siwo Dea Agbe Afɔku Me

Ne asrã mele kansadɔnɔ ŋu o gɔ̃ hã la, dɔléle vɔ̃ɖi si le dɔ wɔm kple egbegbe kansadɔdamɔnu (atikewɔmɔnu, keklẽŋusẽ, kple dɔlélenutsiŋutete ƒe mɔxexeɖedɔléle nu ƒe mɔxenuwo) ate ŋu ahe xɔtuɖoɖo alo lãmenugbagbeviwo ƒe dɔwɔwɔ ƒe kuxi atɔ̃ aɖewo koŋ vɛ siwo ahiã be woakpɔ egbɔ enumake le dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ:

Kansa Ŋuti Nudzɔdzɔ Kpata Nusi Gbɔ Wòtso Vevietɔ Aflaga Dzĩ ƒe Nuxlɔ̃amedzesiwo le Aƒeme Kpekpeɖeŋu Gbãtɔ & Kɔdzi ƒe Atikewɔwɔ Enumake
1. Akɔta ƒe Ʋuʋudedi Vɔ̃ɖi (MSCC) Tumor metastasis (vevietɔ tso no, prostate, lãkusi, ayiku, alo myeloma me) si tsina le aklã ƒe akɔtaƒu me eye wòtena ɖe aklã alo cauda equina dzi. Dzesi 1 lia (90% le dɔlélewo me): Akɔta alo kɔ ƒe vevesese yeye alo esi le sesẽm ɖe edzi si vɔ̃ɖi wu ne mlɔ aba dzi le zã me alo ne èle kɔdzi/tete ɖe ame dzi.
Dzesi siwo dzena le megbe: Afɔ siwo kpekpe/gbɔdzɔ, azɔlizɔzɔ si meli ke o, lãmetutudɔ si le tsatsam yi afɔ/ƒodo dzi, alo aɖuɖɔtoe sesẽ / dɔgbo ƒe dɔmawɔmawɔ nyuie.		 Ƒo ka na 911 / 112 / 999 alo yi ER enumake (ne afɔwo tu keŋkeŋ hena \(>24\text{ va ɖo }48\text{ gaƒoƒo}\) ko la, ƒã hafi azɔlizɔzɔ trɔna gbɔna).
Kɔdzi: Enumake Dexamethasone si wozãna le IV me si ƒe agbɔsɔsɔme sɔ gbɔ (\(10\text{ va ɖo }16\text{ mg}\)) + Akɔta Bliboa ƒe MRI kpata + keklẽŋusẽ si wozãna kpata alo ahɔhɔ̃mekawo ƒe dɔwɔwɔ ƒe ʋuʋu.
2. Superior Vena Cava (SVC) Dɔléle . Aɖuɖɔtoe me dɔdzẽ, ʋumenugbagbeviɣidɔ, alo ʋuka si me ʋu sina tona le akɔta ƒe akpa si le etame si le mimim la xea ʋuka gã (superior vena cava) si naa ʋu tso ta, kɔ, kple abɔwo me trɔna yia dzia me. Mo, kɔ, kple ŋkumeʋuʋu, vuvu (vevietɔ le ŋdi me); awudziwui ƒe kɔla si le sesẽm; ʋuka siwo le dodom le kɔ kple akɔta ƒe gli me; mo dzĩ/blɔ ne èle bɔbɔm ɖe ŋgɔ (Pemberton ƒe dzesi); gbe si me kɔ, kɔdzi, taɖuame, alo stridor. Na dɔnɔa nanɔ tsitrenu le dzidzenu 45 va ɖo 90 (mègamlɔ wo gbadzaa gbeɖe o, si wɔnɛ be ta/yamɔ ƒe ʋukawo ƒe ʋuʋu ɖe edzi).
Ƒo ka na 911 / 112 / 999 ne stridor, tɔtɔ, alo gbɔgbɔtsixetsixe sesẽ.
Kɔdzi: Vovototo Akɔta CT, endovascular SVC stenting, steroids / chemo / keklẽŋusẽ.
3. Dɔdzẽ ƒe Ʋuʋu ƒe Dɔléle (TLS) Kansa lãmenugbagbevi miliɔn geɖe ƒe gbagbã kabakaba ŋutɔ gaƒoƒo 12 va ɖo ŋkeke 7 le atikewɔmɔnu, steroids, venetoclax, alo CAR-T dɔdamɔnu zazã gɔmedzedze megbe (vevietɔ le ʋumenugbagbeviɣidɔ alo ʋumenugbagbeviɣidɔ si ƒe ɖoƒe kɔkɔ me), lãmenugbagbeviwo me potassium, phosphorus, kple uric acid tsɔtsɔ ƒu gbe ɖe ʋua me esime wole calcium ɖiɖim. Aɖuɖɔtoe sesẽ, ʋuʋudedi, aɖuɖɔtoe, kuviawɔwɔ si gbɔ eme, lãmekawo ƒe ʋuʋu alo asi/afɔ ƒe ʋuʋu si le veve sem (tetany tso calcium si mesɔ gbɔ o me), aɖuɖɔ si do viviti/alilikpo alo esi tɔ (ayiku ƒe dɔmawɔmawɔ nyuie), alɔ̃madɔmadɔ, kple dzi ƒe ʋuʋu si wua ame (tso potassium si sɔ gbɔ me). Ƒo ka na 911 / 112 / 999 alo yi ER enumake; xe mɔ ɖe nuɖuɖu/nu siwo katã me potassium le kple NSAID-tikewo nu.
Kɔdzi: ECG si me lifi 12 le enumake, tsidede IV me dzikutɔe, rasburicase (elɔ̃a uric acid kristalo enumake), allopurinol, kple potassium/calcium xɔname.
4. Hypercalcemia ƒe Dɔléle Vɔ̃ɖi . Ƒu ƒe gbagbã alo parathyroid hormone-related protein (PTHrP) ƒe dɔdzẽ ƒe dodo si nana ʋu me calcium sɔa gbɔ afɔkutɔe (\(>3.0\text{ va ɖo }3.5\text{ mmol/L}\) alo \(>12\text{ va ɖo }14\text{ mg/dL}\)). "Ƒuwo, Ɣlidodo, Tagbɔdɔléle": Tsikɔwuame si nu metsina o (polydipsia), aɖuɖɔtoe gã enuenu (polyuria si hea tsi vɔ le ame ŋu vevie), dɔmeɖui sesẽ, ʋuʋudedi/ʋuʋudedi, ƒu ƒe vevesese si nu sẽna ɖe edzi, kple tɔtɔ vivivi, alɔ̃dɔdɔ, alo alɔ̃madɔmadɔ. Yi Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ enumake; na dɔnɔa nade tsi nenye be enɔ ŋudzɔ eye wòle nu mimim dedie ko hafi.
Kɔdzi: Dziku 0.9% Saline IV ƒe tsidede si sɔ + zoledronic acid / pamidronate, calcitonin, alo denosumab dodo ɖe ʋuka me.
5. Neutropenic Enterocolitis (Typhlitis) & Dɔlélenutsiŋutete ƒe dɔdamɔnu Dɔléle / Aklãdɔ Typhlitis: Dɔlékui siwo wua ame ƒe gege ɖe ɖusime dɔgbo (cecum) me le neutropenia sesẽ me.
Dɔlélenutsiŋutete ƒe Dɔlékuiwutikewo (Pembrolizumab, Nivolumab, Ipilimumab): Dɔlélenutsiŋutete ƒe amedzidzedze ɖe lãkusi, dɔgbo, dzi, aklã, alo pituitary/thyroid dzi.		 Typhlitis: Asrã + ɖusime ƒodo ƒe vevesese (srɔ̃a appendicitis) + tsi alo ʋu ƒe aɖuɖɔtoe.
Dɔlélenutsiŋutete ƒe atikewɔwɔ: Aɖuɖɔtoe sesẽ (\(>4\text{ to }6\text{ stools/day}\)), kɔdziyiyi yeye ƒuƒu/gbɔgbɔ kpuie, ɖeɖiteameŋu si gbãa ame/BP si bɔbɔ (adrenal crisis), alo akɔtave (myocarditis).		 MÈGANO atikekui siwo woƒlena le atikedzraƒe o (loperamide/Imodium) GBE ne asrã le ŋuwò, ʋu le dodom le ŋuwò, alo nèle dɔlélenutsiŋutete ƒe dɔdamɔnu zãm kansadɔdala ƒe mɔɖeɖe tẽ manɔmee (aɖiwo léle ɖe dɔgbo si me dɔdzẽ le me ate ŋu ana aɖi megacolon kple dɔgbo nado). Yi ER enumake hena dɔlékuiwutike siwo wodona ɖe ʋuka me alo methylprednisolone si wodona ɖe ʋuka me ƒe agbɔsɔsɔ gã.

Afɔɖeɖe ɖesiaɖe ƒe beléle do ŋgɔ na kɔdziyiyi esime wole dzadzram ɖo ɖe Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ

Afɔɖeɖe 1: Alesi Nàwɔ Axɔ Dzoxɔxɔ Si Sɔ Dedie Le Dɔnɔ Si Wozãna Le Atike Siwo Wozãna Me

  1. Zã dzoxɔxɔdzidzenu si wotsɔa nu me (aɖe te), tympanic (to), alo temporal artery (ŋgonu) ƒe dzoxɔxɔdzidzenu.
  2. Ne ɖeko dɔnɔa no tii dzodzoe alo tsikpetsi la, lala aɖabaƒoƒo 15 va ɖo 20 hafi nàno dzoxɔxɔ si woano ale be woagatrɔ nuxexlẽa alakpatɔe o.
  3. Wode Se Ðe Edzi Kpuie: Mègazã Dzoxɔxɔdzidzenu si Le Aɖuɖɔ Me Gbeɖe O.
  4. Atikewɔwɔ gblẽa nu le lãkusi me lãmenugbagbevi siwo mãna kabakaba siwo le dɔgboa ƒe mɔ̃ bliboa me tso nu me va ɖo aɖuɖɔtoe me (mucositis). Dzoxɔxɔdzidzenu sesẽ aɖe ƒe nugbɔ (alo atikekui, enema, alo tampon) tutu ɖe dɔgboa me ate ŋu ana aɖatsi suesuesue aɖe nado le dɔgboa ƒe akpa si mebɔbɔ o la me, si ana E miliɔn geɖe nado. coli kple dɔgbo me dɔlékui siwo me ya mele o be woage ɖe ʋukawo me enumake (dɔlékuiwo ƒe agbɔsɔsɔ) eye wòahe ʋuka me ʋuʋudedi si me afɔku le alo ʋu si dzi womate ŋu aɖu o vɛ ne ʋumenugbagbevi dzĩwo mesɔ gbɔ o (thrombocytopenia).

Afɔɖeɖe 2: Dzro "Atɔ̃ Ɣla" Dɔlékuiwo Geɖewo Me

Ne èle nu ƒom na dɔnɔdzikpɔla si kpɔa kansadɔlékuiwo me toto me alo nèle ʋu lalam la, tsɔ ŋku lé ŋku ɖe teƒe atɔ̃ siawo ŋu (mègamimi, ƒo, alo ƒo abi aɖeke gbeɖe o) eye nàgblɔ nusi nèkpɔ: 1. Central Venous Access Device (Port-a-Cath, PICC Line, alo Hickman Tunnelled Catheter): Kpɔ ŋutigbalẽ si le akɔta ƒe ʋɔtru alo alɔnu PICC line dzi evɔ màɖe atike si me dɔlékui mele o si me kɔ la ɖa o. Ðe fu, vuvu, dzoxɔxɔ, ʋeʋẽ, alo ɣie ƒe ƒuƒu aɖe le mɔ̃a ƒe mɔa dzia? Ðe dzoxɔxɔ alo vuvɔ si ʋuʋuna dze egɔme le miniti 30 va ɖo 60 me le tsilele alo ʋudzeƒea zazã vɔ megbe? (Dzesi nyanyɛ aɖe si fia be ʋuka si me ʋu sina tona le ʋuka me si me ʋu sina tona le ʋuka me; ele be kɔdzidɔwɔlawo naɖe ʋu ƒe dekɔnuwo tso melidzeƒea hafi woatso nya me le alesi woadae ŋu.) 2. Nu, Aɖu, kple Kɔ (Oral Mucositis): Klẽ telefon ƒe akaɖi ɖe nu me. Ðe abi dzĩ siwo le veve sem, teƒe siwo le abe curd ɣi ene (thrush / candidiasis), ʋu si le dodom le aɖuwo me, alo tsi mimi sesẽa lia? 3. Aɖuɖɔtoewo kple Yagbɔgbɔ: Xlẽ gbɔgbɔ agbɔsɔsɔme si dɔnɔa xɔ le sɛkɛnd 60 me le ɖiɖiɖemeɣi (gbɔgbɔ ƒe agbɔsɔsɔme gbɔgbɔ si wu 20 va ɖo 22 le miniti ɖeka me nye nuxlɔ̃amedzesi kaba be dɔlékuiwutike alo aklãdɔ le ame ŋu ne mekɔ akɔta o gɔ̃ hã) eye nàlé ŋku ɖe asibidɛ ƒe ʋu ƒe sisi ƒe oximeter ŋu ​​ne eli. 4. Ƒodo kple Aɖuɖɔtoe ƒe Nuto: Bia dɔnɔa nenye be ƒodo ƒe ɖusime veve aɖe (typhlitis) alo veve, dzobibi, alo vevesese aɖe le eŋu le akɔta alo asike ƒe ƒu ŋu ne ebɔbɔ nɔ anyi alo le aɖuɖɔ tom (perianal cellulitis nye Gram-negative kple anaerobic sepsis si dea agbe afɔku me ƒe dzɔtsoƒe si ɣla enuenu le neutropenic me dɔnɔwo). 5. Aɖuɖɔ kple Ŋutilã: Bia nenye be aɖuɖɔɖɔɖɔ meɖea dzi ɖi o, edzena abe alilikpo alo pink ene, alo eƒe lolome dzi ɖe kpɔtɔ ŋutɔ le gaƒoƒo 12 siwo va yi me.

Afɔɖeɖe 3: Dzra Thrombocytopenia (Ʋumenugbagbeviɣidɔ si mebɔ o) dzi le ɣeyiɣi ɖeka me

Esi wònye be atikewɔmɔnu tea ƒumeŋuɖui bliboa ɖe to ta la, zi geɖe ŋutɔ la, ʋumenugbagbevi dzĩwo mebɔ o (neutropenia) dɔnɔ si ƒe ʋumenugbagbevi dzĩwo (thrombocytopenia, vevietɔ ne ʋumenugbagbevi dzĩwo ɖiɖi wu \(10,000\text{ va ɖo }20,000/\mu\text{L}\)) le ɣeyiɣi ma ke tututu me: - Kpɔ afɔkpodzi, afɔkpodzi, kple abɔta ƒe ŋutigbalẽ ɖa be teƒe suesuesue siwo le dzo dam alo aŋutiɖiɖi siwo mevuna ne wozi wo dzi o (petechiae), abi doviviti siwo womenya o (ecchymoses), alo ʋu ƒe ʋuʋu le nu me (wet purpura) hã. - Ne ʋu le ŋɔti me alo aɖu me ʋu le dɔnɔa ŋu kpe ɖe dzoxɔxɔ ŋu la, na woanɔ tsitrenu nàbɔbɔ ɖe ŋgɔ, nàƒo ŋɔti falɛfalɛ si le ete la atraɖii aɖabaƒoƒo 20 (kpɔ ʋu si dona le ŋɔti me), eye nàgblɔe na dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ enumake elabena woate ŋu ahiã be woado ʋumenugbagbeviɣidɔ kpata kpe ɖe woƒe dɔlékuiwutike siwo wozãna le ʋuka me ŋu.

Afɔɖeɖe 4: Nuxlɔ̃ame Tɔxɛ Kpata na CAR-T Lãmenugbagbeviwo Kple Dɔlékuiwutike Bispecific Dɔnɔwo (CRS kple ICANS) .

Ne dɔnɔ aɖe xɔ CAR-T cell therapy (chimeric antigen receptor T-cell therapy) alo bispecific T-cell engager antibody nyitsɔ laa na ʋumenugbagbeviɣidɔ, ʋumenugbagbeviɣidɔ, alo multiple myeloma le kwasiɖa 4 siwo va yi me la, dzoxɔxɔ kpata ƒe nu eve siwo ate ŋu ade eƒe agbe afɔku me le ɣeyiɣi ɖeka me: 1. Neutropenic Bacterial Sepsis (ehiã be woazã dɔlékuiwutikewo enumake aɖabaƒoƒo 60 le ʋuka me), EYE 2. Cytokine Release Syndrome (CRS) kple Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS): Dɔlélenutsiŋutete ƒe dɔwɔwɔ gã si hea dzoxɔxɔ sesẽ vɛ (\(>38.0^\circ\text{C}\) va ɖo \(40.5^\circ\text{C}\)), ʋu ƒe sisi dzi ɖena kpɔtɔna, oxygen ƒe ɖiɖi, kple ahɔhɔ̃mekawo ƒe tɔtrɔ kpata (ʋuʋudedi, asi ƒe nuŋɔŋlɔ tɔtrɔwo, nyawo didi ƒe sesẽ, tɔtɔ, alo alɔ̃madɔmadɔ). - Afɔɖeɖe si wòle be nàwɔ: Tsɔ dɔnɔa ƒe CAR-T / Bispecific Wallet Card fia ɣesiaɣi le triage kpata me enumake; tsɔ kpe ɖe dɔlékuiwutike siwo wozãna le IV me siwo ƒe dɔwɔwɔ keke ta ŋu la, dɔnɔ siawo hiã be woado interleukin-6 receptor antagonist tocilizumab kple/alo corticosteroids si wowɔ ɖeka kple woƒe lãmenugbagbeviwo ƒe dɔdaƒea kpata.

Kadodo ƒe nuŋɔŋlɔ si sɔ pɛpɛpɛ na 911 / 112 / 999 kple Emergency Triage

Numekukuwo ɖee fia be kansa dɔnɔ siwo ŋu neutropenic le la kpea fu zi geɖe le megbedede si me afɔku le me le afisiwo amewo sɔ gbɔ ɖo le xɔ si me wowɔa dɔ kpata le me negbe ɖe dɔnɔa alo ƒomea me tɔ gblɔ dɔdamɔnu ƒe nya siwo nye "Chemotherapy Neutropenic Sepsis: 60-Minute Antibiotic Window" le kadodo gbãtɔ me ko hafi. Zã nuŋɔŋlɔ sia nya ɖe nya nu:

  • Ne èle ka ƒom na 911 / 112 / 999 (ne vuvɔ, taɖuame, gbɔgbɔtsixetsixe, alo tɔtɔ le eme):

    "Mehiã dɔnɔdzikpɔʋu le [Adrɛs Teƒe] le esi wosusu be Neutropenic Sepsis ta. Dɔnɔa nye [Ƒe] ƒe [ŋutsu/nyɔnu] si le atikewɔmɔnu zãm na [Kansa Ƒomevi], kple woƒe atikewɔmɔnu mamlɛtɔ si wodo nɛ le [Ŋkeke, ŋkeke X siwo va yi] dzi]. [Eƒe/Eya] ƒe dzoxɔxɔ nye [X degree Celsius / Fahrenheit] si kpe ɖe eŋu [ʋuʋudedi / taɖuame / gbɔgbɔtsixetsixe / tɔtɔ], eye wotsɔ [akɔta Port-a-Cath / alɔnu PICC fli] de eme.Míena Tylenol alo ibuprofen aɖeke o."

  • Ne èle afɔ ɖem yi Emergency Department Triage Desk (ne èɖo ʋu va ɖo):

    "Dɔnɔ sia le atikewɔmɔnu si le dɔ wɔm dzi (Ŋkeke [X] le atike dodo vɔ megbe, le nadir fesrea me) eye Neutropenic Fever si nye [X.X°C / XXX.X°F] le esi. [eƒe] Oncology Neutropenic Sepsis Alert Card ye nye esi. Le ASCO, IDSA, kple NICE ƒe mɔfiamewo nu la, [eƒe] hiã be woaɖe eɖokui ɖe aga enumake, peripheral kple Port-a-Cath ʋu dekɔnuwo, kple dɔlékuiwutike siwo ƒe dɔwɔwɔ keke ta si wodona zi gbãtɔ le ʋuka me le miniti 60 me tso esime wotso wo me."

  • Ne dɔnɔa le Dɔlélenutsiŋutete ƒe Dɔdamɔnu (Checkpoint Inhibitors abe Pembrolizumab/Keytruda, Nivolumab/Opdivo, alo Ipilimumab/Yervoy) zãm:

    "Nya Vevi aɖe na Triage: Dɔnɔ sia le Cancer Immunotherapy ([Atike ƒe Ŋkɔ]) xɔm, menye atikewɔmɔnu xoxowo ɖeɖeko o. Woƒe dzesiwo ateŋu anye Immune-Related Adverse Event (irAE) abe autoimmune pneumonitis, colitis, myocarditis, alo adrenal crisis, si hiã be woakpɔ oncology enumake na corticosteroids siwo ƒe agbɔsɔsɔme sɔ gbɔ tsɔ kpe ɖe dɔlékuiwo ƒe mɔxexeɖedɔléle nu ŋu."

Nusiwo woaxɔ le miniti 2 me na Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ ƒe Go-Bag

  • Dɔnɔa ƒe "Chemotherapy / Immunotherapy Wallet Alert Card" (ɖea atike ƒe ɖoɖo si sɔ pɛpɛpɛ, ŋkeke si dzi wowɔ dɔ mamlɛtɔ, kansadɔdala ƒe gaƒoƒo 24 ƒe pager/telefon xexlẽdzesi, kple melidzeƒe ƒe ƒomevi fiana).
  • Port-a-Cath dzesidegbalẽvi alo power-injectable port fob (gblɔna na dɔnɔdzikpɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ nenye be akɔta ƒe ʋɔtrua nye "Power-Injectable" na CT scan ƒe vovototo kple Huber aŋe [\(3/4\text{-inch}\) vs. \(1\text{-inch}\)] ƒe lolome si sɔ na melidzeƒea).
  • Numbing cream (lidocaine/prilocaine EMLA cream) ne woŋlɔe nɛ: ne ètsɔ numbing cream si woŋlɔ nɛ ƒe dab sisi ɖe akɔta Port-a-Cath si wotsɔ plastic wrap tsyɔ esime nèle ʋua me yina kɔdzi la nana ŋutigbalẽa tsia dzodzodzoe le miniti 30 me eyata ne ètsɔ Huber aŋea ge ɖe melidzeƒea la, vevesese aɖeke mele eme o.
  • Aƒeme atike siwo katã wozãna fifia (vevietɔ dɔlékuiwutike ɖesiaɖe si xea mɔ na dɔléle abe levofloxacin alo trimethoprim-sulfamethoxazole, dɔlékuiwutikewo abe fluconazole/posaconazole, dɔlékuiwutikewo abe acyclovir, tsitsinu ƒe atikewo abe pegfilgrastim [Neulasta] alo filgrastim [Neupogen], kple ʋumenugbagbeviɣitikewo).
  • Telefon ƒe charger kple spare mask dzadzɛ.

Mɔxexe ɖe dɔlékuiwo xɔxɔ gbesiagbe nu le Chemotherapy Nadir (Ŋkeke 7 vaseɖe 14) .

Togbɔ be afɔɖeɖe aɖeke mexea mɔ na neutropenic fevers 100 le alafa me o (elabena dɔlékui akpa gãtɔ tsoa dɔnɔa ŋutɔ ƒe nuɖuɖumeŋusẽ ƒe numiemie siwo sɔ gbɔ) hã la, se siawo siwo wotu ɖe kpeɖodzi dzi dzi wɔwɔ le wò ŋkeke siwo dzi womexlẽa nu boo o me ɖea kɔdziyiyi si woate ŋu axe mɔ na dzi kpɔtɔna: 1. Nu me Beléle (Mɔxexe Ðe Mucositis ƒe Geɖe Nu): Klɔ nu zi 4 gbesiagbe (le nuɖuɖu ɖesiaɖe megbe kple hafi mlɔ anyi) kple \(1/2\text{ teaspoon}\) dze kple \(1/2\text{ teaspoon}\) baking soda (sodium bicarbonate) si wotsɔ \(240\text{ mL}\) (\(8\text{ ounces}\)) si me wode tsii o. ƒe tsi dzodzoe. Zã aɖututu si fa miamiamia ŋutɔ, eye nàƒo asa na aɖuɖɔtoe siwo wotsɔa aha sesẽ wɔe siwo wodzrana siwo ƒua nu me eye wògbãnɛ. 2. Preventing Constipation & Anal Fissures: Chemotherapy kple atike siwo tsia aɖuɖɔtoedɔ nu (abe ondansetron/Zofran ene) nana ame ƒe dɔgbo ƒe ʋuʋu sesẽ. Ne wole agbagba dzem be yewoato aɖuɖɔ sesẽ aɖe me la, evuvua akɔta ƒe lãkusi si mebɔbɔ o (anal fissure), si wɔnɛ be agbo aɖe nɔa dɔgboa me dɔlékuiwo me tẽ be woage ɖe ʋua me. No aɖuɖɔtoemefamɔ̃/aɖuɖɔtoemetike siwo kansadɔdala kafu na wò kaba, no tsi geɖe, eye mègazã dɔgbo me tsi alo enemas gbeɖe o. 3. Nuɖuɖu & Asi Dzadzɛnyenye: Klɔ asi kple adzalẽ kple tsi dzodzoe sɛkɛnd 20 hafi nàɖu nu kple le tsileƒe zazã vɔ megbe. Miɖa lã, koklolã, tɔmelã, kple aziwo katã nyuie ɖe dzoxɔxɔ si le ememe si le dedie nu, klɔ atikutsetse kple amagbe ƒuƒuwo nyuie, eye nàƒo asa na nyinotsi siwo wometsɔ dɔlékuiwutike o, aŋgba ƒuƒu siwo wometsɔ dɔlékuiwutike wɔe o, tɔmelã ƒuƒu/sushi ƒuƒu, kple nuɖuɖu siwo woɖa le kplɔ̃ dzi siwo bɔbɔ nɔ xɔme ƒe dzoxɔxɔ nu. 4. Se Pegfilgrastim (Neulasta) Ƒu ƒe Vevesese kple Dzoxɔxɔ Nyateƒetɔ gɔme: Wodoa ʋumenugbagbevi ɣiwo (pegfilgrastim alo filgrastim, G-CSF) na dɔnɔ geɖe le gaƒoƒo 24 le atikewɔwɔ vɔ megbe. Esi ƒumeŋuɖui wɔa neutrophil yeyewo kabakaba le ŋkeke 2 va ɖo 5 siwo kplɔe ɖo me ta la, zi geɖe la, dɔnɔwo sea veve vevie le woƒe akɔta, no me ƒu, kple akɔta (zi geɖe la, loratadine [Claritin] ɖenɛ fiana ne kansaŋutinunyala da asi ɖe edzi). Gake, mègasusui gbeɖe be dzoxɔxɔ si nye \(38.0^\circ\text{C}\) (\(100.4^\circ\text{F}\)) alo esi wu nenema la nye "tso Neulasta ƒe tudadaa me ko": lé ŋku ɖe wò dzoxɔxɔ ŋu ɣesiaɣi eye nàyɔ kansadɔdala enumake be dzoxɔxɔ aɖeke mele ŋuwò o.

Wɔ nusɔsrɔ̃ aɖe

Kpekpeɖeŋunadɔ gbãtɔ kple CPR ƒe nusɔsrɔ̃ si ŋu woɖo kpee tso Atitsoga Dzĩ Habɔbɔ, Amerika Dzi Habɔbɔ, St John Ambulance, alo nutoa me dɔnɔdzikpɔlawo gbɔ la, efiaa dɔnɔdzikpɔlawo kple ƒomea me tɔwo alesi woade dzesi dɔlékuiwutike, ʋu ƒe sisi ƒe ʋuʋu, kple gbɔgbɔ kpata ƒe dzesi gbãtɔwo eye woawɔ ɖoɖo ɖe beléle kpata siwo xɔa ame ƒe agbe ŋu.

Nya siwo wobiaa amewo enuenu

Nukatae Tylenol (acetaminophen / paracetamol) alo ibuprofen nono na asrã alo taɖuame si nu mesẽ o nye afɔku le atikewɔɣi?

Ne atikewɔmɔnu na wò ʋumenugbagbevi ɣiwo (neutrophils) ɖiɖi la, wò ŋutilã mate ŋu awɔ ʋuʋudedi, abi, alo avuvu le teƒe ɖeka ne dɔlékuiwo va dze wo dzi o, eyata zi geɖe la, dzoxɔxɔ si le dzidzim ɖe edzi nyea nuxlɔ̃amedzesi ÐEKA KO si fia be ʋumenugbagbeviɣidɔ si ate ŋu ade ame ƒe agbe afɔku me dze egɔme. Acetaminophen, paracetamol, ibuprofen, alo aspirin nono ɖea wò dzoxɔxɔ dzi kpɔtɔna le mɔ si wowɔ nu gaƒoƒo geɖe eye wòɣlaa nuxlɔ̃amedzesi ma esime dɔlékuiwo le dzidzim ɖe edzi kabakaba le wò ʋu me. Mègano atike aɖeke si ɖea dzoxɔxɔ dzi kpɔtɔna le atikewɔɣi gbeɖe ne mèlé ŋku ɖe wò dzoxɔxɔ ŋu gbã eye mèxɔ mɔɖeɖe tẽ tso wò kansadɔlélawo ƒe ƒuƒoƒoa gbɔ o.

Dzoxɔxɔdzidzenu ƒe nuxexlẽ kae tututu wobuna be enye atikewɔwɔ ƒe nɔnɔme kpata le atikewɔɣi?

Le dukɔwo dome kansaŋutinunya ƒe mɔfiamewo (ASCO, IDSA, kple ESMO) nu la, neutropenic fever ƒe nudzɔdzɔ kpata nye nu me ƒe dzoxɔxɔ ɖeka ɖesiaɖe si nye 38.3°C (101.0°F) alo esi wu nenema, ALOO dzoxɔxɔ si woano le nu me si nye 38.0°C (100.4°F) alo esi wu nenema si anɔ anyi gaƒoƒo 1 blibo (UK NHS kɔdzi geɖe zãa se si sesẽ wu gɔ̃ hã be woaxlẽe zi ɖeka 38.0°C / 100.4°F ƒe dzoxɔxɔ). Tsɔ kpe ɖe eŋu la, ne lãmetutudɔ si le ʋuʋum (sesẽ), taɖuame, tɔtɔ, gbɔgbɔtsixetsixe, alo dzoxɔxɔ si bɔbɔ ɖe anyi le mɔ si mesɔ o nu le 36.0°C (96.8°F) teƒe la, ke enye nudzɔdzɔ kpata enumake ne dzoxɔxɔdzidzenu ƒe nuxexlẽ si lolo gɔ̃ hã.

Nukatae mɔfiame siwo ku ɖe nudzɔdzɔ kpatawo ŋu xe mɔ ɖe dzoxɔxɔdzidzenu si wozãna le dɔgboa me alo atike si wotsɔna tsia dɔgboa me zazã nu le dɔnɔ si le atikewo zãm me?

Atikewo zazã ɖea ʋumenugbagbevi dzĩ siwo le dɔgboa kple dɔgbowo me si le tsɛ eye wògbɔdzɔna esime wòɖea ʋumenugbagbevi ɣi siwo wɔa avu kple dɔlékuiwo kple ʋumenugbagbevi dzĩ siwo ʋua ʋu siaa dzi kpɔtɔna le ɣeyiɣi ɖeka me. Dzoxɔxɔdzidzenu, atikekui, alo enema dede dɔgboa me ate ŋu avuvu alo avuvu dɔgbo ƒe gli si mebɔbɔ o la bɔbɔe, si ana dɔgbo me dɔlékui miliɔn geɖe nage ɖe ʋuka me tẽ (si ahe Gram-negative sepsis si wua ame vɛ) eye wòana ʋu si dona le dɔgboa me vevie.

Nukatae akɔtave le kansadɔnɔ ŋu bia be woalé ŋku ɖe eŋu kpata be eƒe aklã me tete ɖe eŋu hã?

Kansa geɖe siwo bɔ (vevietɔ no, ʋuka, lãkusi, ayiku, kple multiple myeloma) ate ŋu akaka ɖe akɔta ƒe ƒuwo me. Ne dɔdzẽ aɖe tsi ɖe aklã me la, dzesi gbãtɔ kekeake si dzena le dɔnɔ siwo wu 90 le alafa me ŋue nye akɔta alo kɔ ƒe vevesese yeye alo esi le sesẽm ɖe edzi (si gavloe ɖe edzi wu ne mlɔ aba dzi alo le kɔdzim) ŋkeke alo kwasiɖa aɖewo hafi afɔawo nagbɔdzɔ alo avuvu. Ne wolé aklãdɔlékui vɔ̃ɖiwo ƒe tete kaba to MRI kpata kple IV dexamethasone ƒe agbɔsɔsɔ gã me esime dɔnɔa gakpɔtɔ te ŋu zɔna la, ekpɔa woƒe azɔlizɔzɔ ƒe ŋutete ta eye wòléa tsinyegoea dzi ɖuɖu me ɖe asi.

Wolé ŋku ɖe dzɔtsoƒewo ŋu

  • American Society of Clinical Oncology (ASCO) kple Infectious Diseases Society of America (IDSA, United States): Asrã kple Neutropenia dzi kpɔkpɔ le gota le ame tsitsi siwo woda dɔ na le dɔléle vɔ̃ɖi ta me: ASCO kple IDSA ƒe Dɔdamɔnu ƒe Mɔfiame yeye (Taplitz et al., Journal of Clinical Oncology) kple IDSA ƒe Dɔdamɔnu ƒe Mɔfiame si ku ɖe... Dɔlékuiwutikewo le Dɔnɔ Siwo Ŋu Neutropenic Siwo Ŋu Kansa Le (Freifeld et al.).
  • Dukɔa ƒe Lãmesẽ Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE, United Kingdom): Neutropenic Sepsis: Mɔxexeɖedɔléle Nu Kple Edzikpɔkpɔ le Ame Siwo Ŋu Kansa Le Me (NICE ƒe Dɔdaƒe ƒe Mɔfiame CG151, si nye aɖabaƒoƒo 60 ƒe ʋɔtru nu yi dɔlékuiwutikewo ƒe sedede) kple Metastatic Spinal Cord Compression in Adults: Risk Assessment, Diagnosis and Management (NICE Guideline NG234).
  • Europa Habɔbɔ si Kpɔa Atikewɔwɔ me Dɔdzẽŋutinunya Gbɔ (ESMO): Febrile Neutropenia Dzikpɔkpɔ: ESMO ƒe Dɔdamɔnu ƒe Mɔfiamewo (Klastersky et al., Annals of Oncology) kple ESMO ƒe Mɔfiamewo le Aɖi Siwo Tso Dɔlélenutsiŋutete ƒe Dɔdamɔnu Me Dzi Kpɔkpɔ Ŋu.
  • National Comprehensive Cancer Network (NCCN, United States): NCCN ƒe Dɔdamɔnu ƒe Mɔfiamewo le Dɔdzẽŋutinunya me: Mɔxexe Ðe Dɔlékui Siwo Do Ƒome Kple Kansa Gbɔ Kple Wo Dada kple Aɖi Siwo Do Ƒome Kple Dɔlélenutsiŋutete ƒe Dɔlélenutsiŋutete ƒe Dzɔdzɔmenuwo Dzikpɔkpɔ.
  • Oncology Nursing Society (ONS) & UK Oncology Nursing Society (UKONS): Acute Oncology ƒe Dɔwɔna Gbãtɔ ƒe Mɔfiamewo kple Gaƒoƒo 24 ƒe Triage Rapid Assessment Toolkit.

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