Feberu ea Neutropenic Nakong ea Tšohanyetso ea Chemotherapy le Kalafo ea Kankere¶

Ho mang kapa mang ea fumanang phekolo ea lik'hemik'hale, phekolo e lebisitsoeng ea moko oa masapo, kapa ho fetisetsa stem cell, feberu e bonolo ha ho mohla e "tšoaeang feela": ke boemo ba tšohanyetso bo behang bophelo kotsing bo bitsoang Febrile Neutropenia (Neutropenic Fever). Chemotherapy e senya lisele tse tšoeu tsa mali tse arohaneng ka potlako tse tsejoang e le neutrophils, sesole sa 'mele se ka pele khahlanong le libaktheria le li-fungus, haholo-holo nakong ea "nadir" fensetere (\(7\text{ ho }14\text{ days}\) ka mor'a ho tšeloa ka chemotherapy). Ha lipalo tsa neutrophil li theohela ho lefela kapa haufi le lefela, libaktheria tse se nang kotsi tse phelang ka tlhaho molomong, maleng, kapa letlalong le haufi le kou e bohareng ea venous li ka hlasela phallo ea mali 'me tsa imena habeli metsotsong e meng le e meng e 20 ntle le ho hlahisa boladu, bofubelu kapa ho khohlela. Ha e tloheloa e sa alafshoe hae esita le lihora tse 'maloa, feberu ea neutropenic e tsoela pele ka potlako ho fihlela e fela. sepsis le septic shock. Ho pholoha ho itšetlehile ka Golden Hour "Door-to-Antibiotic" Rule: ho fihla lefapheng la tšohanyetso hang-hang kahoo lithibela-mafu tse pharalletseng tse kenang methapong li kenella **ka nako ea metsotso e 60 ea triage **, mme ha ho mohla li patang feberu e ntseng e phahama ka acetaminophen (paracetamol) kapa ibuprofen pele o letsetsa sehlopha sa oncology.

Etsa sena hona joale¶

1. Sheba mocheso oa molomo (molomo) kapa oa tympanic/temporal hang-hang 'me u sebelise molao o tiileng oa \(38.3^\circ\text{C}\) (\(101.0^\circ\text{F}\)) / \(38.0^\circ\text{C}\) (\(100.4^\circ\text{F}\)) rule. (ID SA American Clinic Society Infect of America) Ho latela ID ea American Clinic Society of America. Oncology (ASCO), European Society for Medical Oncology (ESMO), le UK NICE guidelines, Neutropenic Fever e hlalosoa e le:
2. Mocheso o le mong ka molomo oa \(38.3^\circ\text{C}\) (\(101.0^\circ\text{F}\)) kapa ho feta, OR
3. Mocheso oa molomo oa \(38.0^\circ\text{C}\) (\(100.4^\circ\text{F}\)) kapa ho feta moo o phehellang hora e le 1 (kapa o lekantsoe habeli bonyane hora e 1 ka ho arohana).
4. *(Tlhokomeliso: Li-trust tse ngata tsa UK NHS le litsi tsa mofets'e li sebelisa moeli o thata le ho feta oa ho bala o le mong oa \(38.0^\circ\text{C}\) [\(100.4^\circ\text{F}\)] hang, kapa \(37.5^\circ\text{C}\) [\(99.5^}\)1 tsatsi ea hau ea mofetše ka linako tsohle ka linako tsohle{1 tekanyo e thata ka ho fetisisa ea karete.)
5. Letsa nomoro ea hau ea tšohanyetso ea sebakeng sa heno hang-hang haeba mokuli a tsielehile, a tsekela, a ferekane, a hema ka thata, kapa khatello e tlase ea mali. Letsetsa 911 United States le Canada, 112 ho pholletsa le European Union, 999 United Kingdom, kapa u bone tsohle. dinomoro tsa tshohanyetso haeba mokuli a e-na le ho tsikinyeha ho sisinyehang (rigors), a ikutloa a akheha ha a eme, pelo ea hae e otla ka potlako (\(>100\text{bpm}\)), a e-na le systolic blood pressure e ka tlaase ho \(100\text{ mmHg}\), kapa a shebahala a le mosehla, a ferekane, kapa a ferekane, esita le haeba thermometer ea bona e baleha e tloaelehileng kapa ka tsela e sa tloaelehang kapa e le tlaase{^C\3$. \(<96.8^\circ\text{F}\)), kaha serame se batang ke mofuta o kotsi ka ho fetisisa oa septic shock.
6. Haeba u tsitsitse ka feberu, letsetsa mohala oa hau oa 24-hour Oncology Triage hang-hang 'me u ee ka kotloloho Lefapheng la Tšohanyetso. Se ke oa ema ho fihlela lihora tsa mosebetsi oa hoseng. E-re motho e mong a khannele mokuli sepetlele hang-hang, 'me u kope ngaka ea oncologist e letetseng ho etela pele ho setsi sa tlhahlobo ea maemo a tšohanyetso e le hore litloaelo tsa mali le lithibela-mafu tse kenang methapong li se li le teng ha li fihla.
7. O SE KE UA fana ka lipilisi tse fokotsang feberu (ha ho acetaminophen, paracetamol, ibuprofen, kapa aspirin) hape le ka mohla u se ke ua sebelisa thermometer ea rectal. Lekanya mocheso tlas'a leleme (oral) kapa ka tlas'a letsoho (axillary; hlokomela hore axillary readings e batla e ka ba \(0.5\c}\circ\text\){0.5^\circ\text$ ka tlase ho feta tse baloang ka molomo, kahoo ho bala ka sephakang \(37.8^\circ\text{C}\) [\(100.0^\circ\text{F}\)] ho lekana le feberu ea molomo).
8. klzzwxh:0130 Hobane mokuli oa neutropenic ha na tšireletso ea 'mele ea ho itšireletsa mafung, a lutse a sa koaheloa ka phaposing e phetheselang ea ho emela maemo a tšohanyetso haufi le bakuli ba khohlela ho kotsi. Hlahisa "Chemotherapy Neutropenic Sepsis Alert Card" ho mooki oa tlhahlobo hang-hang 'me u kope ho behoa **kamoreng e ka thōko ea tlhahlobo ** hang-hang.
9. ** Hlahloba tse ling tse 'nè tse kholo tsa Oncologic Emergency.** Ha u ntse u lokisetsa lipalangoang, skrine ka potlako bakeng sa Malignant Spinal Cord Compression (bohloko bo bocha ba morao bo nang le bofokoli ba leoto, bohatsu, kapa bothata ba senya), Superior Vena Cava (SVC) Syndrome (ho ruruha sefahleho/molala le ho hema ka thata), *Tumor Moroto, Lefu la moroto, letshosa ho otla ha pelo nakong ea matsatsi a ho qala chemotherapy), le Hypercalcemia of Malignancy (lenyora le feteletseng, ho ntša metsi khafetsa, ho pipitleha, le pherekano).

Emergency triage and cancer treatment crisis crisis tree¶

Sebelisa setšoantšo sena sa kliniki ho hlahloba matšoao leha e le afe a matla ho mokuli ea ntseng a phekoloa kankere kapa nakong ea libeke tse 6 tsa chemotherapy.

flowchart TD
    Start["Mokuli oa Mofets'e ho Chemotherapy, Immunotherapy, <br/>kapa Radiation e Hlahisa Matšoao a Haholo"] --> SepsisFlags{"Mohato oa 1: Sheba Hang-hang Septic Shock / Crisis Red Flags<br/>1. Ho sisinyeha ha serame (ho tsitsa), leha ho se mocheso o phahameng?<br/>2. Hypothermia: Mocheso o ka tlase ho 36.0°C (96.8°F)?<br/>3. Ho tsekela, ho akheha, pherekano, kapa puo e sa hlakang?<br/>4. Ho hema ka thata, ho hema kapele, kapa ho opeloa ka sefubeng?<br/>5. Bofubelu, boladu, kapa bohloko holim'a Port-a-Cath / PICC / Hickman line?"}

    SepsisFlags -->|"YES: E mong le e mong o teng"| Call911["CRITICAL ONCOLOGIC SEPSIS / CRISIS:<br/>1. Letsetsa 911 / 112 / 999 Hang-hang bakeng sa Ambulense<br/>2. Phatlalatsa 'Chemotherapy Neutropenic Sepsis Emergency'<br/>3. Qobella Sepheo sa Metsotso ea 60 ho ea ho IV-Antibiotic<br/>4. Lula u paqame fatše (kapa u otlolohile haeba u haelloa ke moea); NPO"]

    SepsisFlags -->|"NO"| TempCheck{"Mohato oa 2: Sheba Mocheso oa Molomo<br/>(O SE KE UA sebelisa thermometer ea rectal)<br/>Na mocheso >= 38.3°C (101.0°F) HANG-HANG<br/>OR >= 38.0°C (100.4°F) bakeng sa hora e le 1?"}

    TempCheck -->|"EE: Moeli oa feberu o ile oa kopana"| NeutFever["TŠIRELETSO EA NEUTROPENIC FEVER:<br/>1. U SE KE UA fana ka Tylenol/paracetamol, ibuprofen, kapa aspirin<br/>2. Letsetsa 24-hour Oncology Triage Line HONA JOALE ha u tsamaea <br/>3. Roala mask ho mokuli; e-ea Lefapheng la Tšohanyetso HONA JOALE<br/>4. Bontša Chemo Alert Card at triage: kopa ho itšehla thajana +<br/> Meetlo ea Mali (Port + Peripheral) & IV Antibiotics < 60 mins"]

    TempCheck -->|"CHE: Ha ho matšoao a feberu kapa sepsis"| OncEmerg{"Mohato 3: Sheba Maemo a Tšohanyetso a Mofets'e oa Sebopeho le Metaboliki:<br/>A. Bohloko bo bocha ba mokokotlo / molala + bofokoli ba leoto, bohatsu, kapa phetoho ea senya?<br/>B. Ho ruruhile sefahleho/molala/matsoho + ho khohlela/ho felloa ke moea le ho feta ha u paqame?<br/>C. Chemo ea morao-rao (matsatsi a 1-7) + cramps, ho nyekeloa ke pelo, moroto o lefifi?<br/>D. Lenyora le feteletseng, pherekano, pipitlelano, bohloko ba masapo?"}

    OncEmerg -->|"A: Bohloko ba mokokotlo + matšoao a neuro"| MSCC["KHATETSO EA HO BONAHANG E LE MALIGNANT SPINAL CORD:<br/>Emergency Spine MRI + High-Dose IV Dexamethasone NOW"]

    OncEmerg -->|"B: Ho ruruha sefahleho / molala + dyspnea"| SVCS["HO belaelloa SUPERIOR VENA CAVA (SVC) SYNDROME:<br/>Lula u otlolohile (45-90 deg); Sefuba sa Tšohanyetso CT + Tlhokomelo ea Oncology"]

    OncEmerg -->|"C kapa D: Mathata a metabolism"| Metabolic["HO LELELEZWA HO HLAHALA KA THULA KAPA HYPERCALCEMIA:<br/>Lefapha la Tshohanyetso HONA JWALE bakeng sa ECG, Electrolytes, & IV Fluids"]

Karolo ea 1: Ho utloisisa Feberu ea Neutropenic le Fensetere ea Kotsi ea "Nadir".¶

1. "Absolute Neutrophil Count" (ANC) le Chemo Nadir ke Eng?¶

Lisele tse tšoeu tsa mali (leukocyte) li kenyelletsa mefuta e mengata ea lisele, empa neutrophils ke lisele tse ka sehloohong tse bolaeang libaktheria. Lingaka li bala Absolute Neutrophil Count (ANC) ka ho atisa palo eohle ea lisele tse tšoeu tsa mali ka peresente ea li-neutrophils tse arohaneng ("segs") le lihlopha tse sa hōlang: - Normal Healthy ANC: \(1,500\text{ho }8,000\text{ liseleng ho microliter }(\mu\text{L})\) (kapa \(1.5\mongolo{ ho }8.0 \nako 10^9/\text{L}\)). - Neutropenia: ANC ka tlase \(1,500\text{ cell}/\mu\text{L}\) (\(<1.5 \times 10^9/\text{L}\)). - Neutropenia e Matla (Kotsi e Phahameng ea Feberu): ANC e ka tlase \(500\text{ cell}/\mu\text{L}\) (\(<0.5 \times 10^9/\text{L}\)), kapa Ka tlase ho \(1,000\text{ cells}/\mu\text{L}\) e lebelletsoe ho theoha ka tlase ho \(548\) nakong ea lihora tse tlang. - Neutropenia e Tebileng (Kotsi e Feteletseng): ANC e ka tlase \(100\text{ cell}/\mu\text{L}\) (\(<0.1 \nako 10^9/\text{L}\)), e atileng nakong ea ho kenngoa ha leukemia e matla kapa ho fetisoa ha stem cell.

Nadir e etsahala neng? Ka mor'a hore ho kenngoe mokhoa o tloaelehileng oa phekolo ea lik'hemik'hale ka har'a methapo ka Letsatsi la 1, li-neutrophil tse seng li ntse li potoloha maling li phela matsatsi a seng makae ha feme ea moko oa masapo e maketse ka nakoana. Ka lebaka leo, palo ea lisele tse tšoeu tsa mali e fihla boemong bo tlaase ka ho fetisisa (the nadir) hangata pakeng tsa Letsatsi la 7 le Letsatsi la 14 ka mor'a chemotherapy (le hoja e ka etsahala neng kapa neng nakong ea phekolo ea letsatsi le letsatsi e lebisitsoeng ka molomo, mahlaseli a kotsi, kapa kankere ea mali e kang leukemia, lymphoma, le multiple myeloma).

2. Hobaneng ha Tšoaetso e shebahala e sa bonahale ka ho felletseng ha o na le Zero Neutrophils¶

Ho motho ea nang le tsamaiso ea 'mele ea ho itšireletsa mafung e tloaelehileng, tšoaetso e totobetse hobane ** limilione tsa li-neutrophils li potlakela setšeng ebe lia shoa , li hlahisa pus e teteaneng e mosehla, letlalo le ruruhileng le khubelu, li-exudates tse bohloko tsa 'metso, kapa li-patches tse tšoeu tse teteaneng sefubeng X-ray: - Ha ho Neutrophils = Ha ho Pus ebile Ha ho Matšoao a khale: Ho mokuli ea nang le bokooa bo matla haholo: - Lefu bacterial pneumonia e bolaeang e ka baka khohlela e se nang letho, phlegm e se nang letho, le X-ray ea sefuba e hlakileng ka ho feletseng, e bontšang feela feberu le ho hema ka potlako hanyenyane. - Tšoaetso e matla haholo ea moroto (urosepsis) e ka baka cheso e se nang letho ha u ntša metsi le ho bontša lisele tse tšoeu tsa mali tse se nang letho (pyuria) holim'a mochini oa moroto, o hlahisa feberu feela. - Letlalo le bolaeang letlalo kapa perirectal cellulitis le pota-potileng anus kapa koung ea venous e bohareng e ka bonts'a ** boladu bo se nang letho kapa lesapo le feto-fetohang, le hlahisa feela ka mofuthu o poteletseng, bopinki bo nyatsehang, kapa bonolo bo sebakeng haufi le feberu. - Temoso ka Corticosteroids Masking the Fever: Bakuli ba bangata ba mofetše ba noa letsatsi le letsatsi kapa beke le beke dexamethasone kapa prednisone (bakeng sa ho ruruha boko, lymphoma, multipleeloma, litla-morao tsa immunotherapy, kapa ho nyekeloa ke pelo). Corticosteroids e hatella ka matla hypothalamus thermostat ea boko. Mokuli ea noang dexamethasone a ka ba le neutropenic bloodstream sepsis e felletseng e nang le mocheso o tloaelehileng oa \(37.0^\circ\text{C}\) (\(98.6^\circ\text{F}\)). Ho bakuli ba noang li-steroids, shebella ho tsikinyeha (ho tsieleha), ho khathala ka tšohanyetso, molikoalikoane, pherekano e tlase, pherekano e tlase, pherekano e tlase, pherekano e tlase, pherekano e tlase. \(36.0^\circ\text{C}\) (\(96.8^\circ\text{F}\)).

3. "Molao oa Lithibela-mafu oa Metsotso e 60 ho isa ho nale"¶

Hang ha libaktheria li kena maling a mokuli ea se nang li-neutrophils (hangata Gram-negative rods joalo ka Escherichia coli, Klebsiella pneumoniae, kapa Pseudomonas aeruginosa e fetisetsang liso tsa melomong tse senyehileng ka chemotherapy [mucositis-] joalo ka mala* mucositis-] kapa mala a mala. Staphylococcus le Streptococcus ho tsoa ho li-catheter tsa venous), lefu le nyoloha haholo ka hora e 'ngoe le e 'ngoe ea tieho. - Taelo ea Sepetlele sa Machabeng: Litaelo tse tsoang ho ASCO, IDSA, ESMO, Surviving Sepsis Campaign, le UK NICE (CG151) li laela hore lefapha le leng le le leng la maemo a tšohanyetso le fane ka tekanyo ea pele ea empiric anti-pseudomonal intravenous beta-lactam antibiotic (joalo ka ctacefepime, piperacill, piperacill/Zozocin] meropenem) ka nako ea metsotso e 60 ha mokuli a kena monyako oa sepetlele, ntle le ho emela hore sephetho sa laboratori ea lisele tse tšoeu tsa mali (CBC) se khutle haeba ho belaelloa neutropenia. - Ho etsahalang metsotsong eo ea pele e 60: Baoki hang-hang ba hula ** lihlopha tse peli tsa litloaelo tsa mali ** (sete e le 'ngoe e huloa ka lumen e' ngoe le e 'ngoe ea mokuli e kentsoeng **Port-a-Cath, line ea PICC, kapa catheter ea Hickman *, le sete e le' ngoe e nkiloeng ho tloha mothapong oa letsoho la peripheral arm), ba hula Complete Blood Count (CBC, phanele ea metabolic hang-hang le antibiotic IV), ka mor'a ho ntša mali. - ** High-Risk vs. Low-Risk Triage (The MASCC Score): Hang ha tekanyo ea pele ea lithibela-mafu ea IV e ntse e sebetsa, litsebi tsa oncologists le lingaka tsa tšohanyetso li bala **Multinational Association for Supportive Care in Cancer (MASCC) Risk Index ** le ** CISNE lintlha ** ho fumana hore na mokuli o tlameha ho lula kamoreng ea ho itšehla thajana ea mokuli (e tlamang, pneumonia, khatello e tlaase ea mali, khatello ea mali, khatello ea mali, khatello ea mali, khatello ea mali, khatello ea mali, khatello ea mali, khatello ea mali, khatello ea mali, khatello ea mali, khatello ea mali, khatello ea mali. kapa mucositis e matla) kapa e ka fetela ho phekolo e behiloeng leihlo ka hloko.

Karolo ea 2: Ho Lemoha Likotsi Tse Ling Tse Hlano Tse Kotsing tsa Oncologic¶

Le ha mokuli oa mofets'e a se na feberu, bofokoli bo matla le kalafo ea sejoale-joale ea mofets'e (chemotherapy, radiation, le **immune checkpoint inhibitors **) e ka baka mathata a mahlano a meralo kapa a metabolism a hlokang tlhokomelo ea hanghang ea lefapha la tšohanyetso:

Mohato ka mohato tlhokomelo ea pele ho sepetlele ha u ntse u itokisetsa Lefapha la Tšohanyetso¶

Mohato oa 1: Mokhoa oa ho Nka Mocheso o Nepahetseng ka Mokhoa o Sireletsehileng ho Mokuli oa Chemotherapy¶

1. Sebelisa sesebediswa sa dijithale sa molomo (tlasa leleme), tympanic (tsebe), kapa thermometer ya mothapo wa temporal (phatleng).
2. Haeba mokuli a noa tee e chesang kapa metsi a leqhoa, ema ** 15 ho metsotso e 20 ** pele o nka mocheso oa molomo e le hore 'malo o se ke oa fetoloa ka bohata.
3. E Hanetsoe ka ho Fetisisa: Le ka mohla U se Ke Ua Sebelisa Rectal Thermometer.
4. Kalafo ea lik’hemik’hale e senya lisele tsa mucosal tse arohaneng ka potlako tse pota-potileng lesapo lohle la mala ho tloha molomong ho ea ho anus (mucositis). Ho sutumelletsa ntlha e thata ea thermometer (kapa suppository, enema, kapa tampon) ka har'a rectum ho ka baka ho taboha ha microscopic leleng le pshatlehang la mokokotlo, ho lumella limilione tsa *E. coli * le likokoana-hloko tsa anaerobic gut ho kena maling hang-hang (bacteremia) le ho etsa hore ho be le sekhahla se kotsi sa perirectal kapa mali a sa laoleheng haeba li-platelet li le tlaase (**thrombocytopenia **).

Mohato oa 2: Lekola "Lits'oants'o Tse Patiloeng Tse Hlano" tsa ho Kena¶

Ha u ntse u bua le mooki oa "oncology triage" kapa u emetse lipalangoang, sheba libaka tsena tse hlano (le ka mohla u se ke ua pepeta, ua phunya, kapa ua hlaba seso) 'me u tlalehe seo u se bonang: 1. Sesebelisoa se Bohareng sa Venous Access (Port-a-Cath, PICC Line, kapa Hickman Tunnelled Catheter): Sheba letlalo holim'a sefuba sa sefuba kapa mohala oa letsoho oa PICC ntle le ho ebola moseho o sa hloekang o bonaletsang. Na ho na le ** bokhubelu, ho ruruha, mofuthu, bonolo, kapa lekhalo le mosehla** haufi le pina ea kotopo? Na feberu kapa ho tsikinyeha ho ile ha qala ka nako ea metsotso e 30 ho isa ho e 60 ka mor'a ho hlatsoa metsi kapa ho sebelisa boema-kepe? (Letšoao la khale la "catheter lumen" ea kolone; basebetsi ba sepetlele ba tlameha ho hula litloaelo tsa mali boema-kepeng pele ba etsa qeto ea hore na ba phekoloe joang.) 2. Molomo, Marinini, le Mmetso (Oral Mucositis): Khantša lebone la fono ka hare ho molomo. A na ho na le liso tse bohloko tse khubelu, maqeba a masoeu a kang curd (thrush / candidiasis), marinini a tsoang mali, kapa bothata ba ho metsa maro? 3. Matšoafo le Phefumoloho: Bala hore na mokuli o phefumoloha hakae ka metsotsoana e 60 ha a phomotse (tekanyo ea ho phefumoloha kaholimo ho 20 ho isa ho 22 phefumoloho ka motsotso ke sesupo sa temoso ea pele ea sepsis kapa pneumonia le ha a sa khohlela) 'me u hlahlobe molumo oa monoana oa oximeter haeba o le teng. 4. Mpa le Perirectal Area: Botsa mokuli hore na o na le mahlaba a ka mpeng a lehlakoreng le letona (typhlitis) kapa bohloko leha e le bofe, ho chesa, kapa ho ba bonolo ho pota-potile anus kapa tailbone ha a lutse kapa a feta setuloana (perianal cellulitis ke mohloli oa khafetsa, o patehileng oa ho beha bophelo kotsing ho bakuli ba nang le lefu la Gram-neigasis). 5. Moroto le Letlalo: Botsa hore na ho ntša metsi ha ho phutholohe, ho bonahala ho le maru kapa ho pinki, kapa molumo oa lentsoe o theohile haholo lihoreng tse 12 tse fetileng.

Mohato oa 3: Laola Thrombocytopenia (Low Platelets) Ka nako e le 'ngoe¶

Hobane chemotherapy e hatella moko oa masapo kaofela, mokuli ea nang le lisele tse tšoeu tsa mali tse tlase (neutropenia) hangata o na le liplatelete tse tlase tsa mali tse kotsi (thrombocytopenia, haholo ha liplatelete li theoha ka tlase ho \(10,000\text{ho isa ho }20,000/\mu\text{L}\)) ka nako eona eo: - Sheba letlalo la maqeba, maqaqailana le liphatla bakeng sa matheba a manyenyane a bofubelu kapa a pherese a sa nyameng ha a hatelloa (petechiae), matetetso a lefifi a sa hlalosoang (ecchymoses), kapa maqeba a mali ka hare ho molomo (wet purpura). - Haeba mokuli a tsoa mali nkong kapa mareneneng a tsoa mali haufi le feberu, li lulise li otlolohile, u tšetlehe ka pele, u tsitlelle nko e tlase e bonolo ka metsotso e 20 (sheba. mali a nko), 'me u bolelle ba phaposi ea tšohanyetso hang-hang kaha ba ka hloka ho tšeloa platelet transfusion ka potlako hammoho le lithibela-mafu tsa bona tsa IV.

Mohato oa 4: Tlhokomeliso e Khethehileng ea Tšohanyetso bakeng sa Bakuli ba CAR-T le Bakuli ba Bispecific Antibody (CRS le ICANS)¶

Haeba mokuli a sa tsoa fumana CAR-T cell therapy (chimeric antigen receptor T-cell therapy) kapa ** bispecific T-cell engager antibody** bakeng sa leukemia, lymphoma, kapa myeloma e mengata nakong ea libeke tse 4 tse fetileng, feberu ea tšohanyetso e na le lisosa tse peli tse kotsi ka nako e le 'ngoe: 1. Neutropenic Bacterial Sepsis (e hlokang hanghang lithibela-mafu tsa IV tsa metsotso e 60), LE 2. Cytokine Release Syndrome (CRS) le Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS): Ts'ebetso e matla ea 'mele ea ho itšireletsa mafung e bakang feberu e matla (\(> 38.0 ^\circ\text{C}\) to \(40.5^\circ\text{C}\)), ho theola khatello ea mali, ho fokotseha ha maikutlo, liphetoho tsa tšohanyetso tsa methapo ea kutlo, ho fetoha ha moea oa oksijene. bothata, pherekano, kapa ho kgena). - Ketso e Tlamang: Kamehla bontša mokuli CAR-T / Bispecific Wallet Card nakong ea tlhahlobo ea tšohanyetso hang-hang; ho phaella ho lithibela-mafu tse pharaletseng tsa IV, bakuli bana ba hloka tsamaiso e potlakileng ea mohanyetsi oa interleukin-6 ** tocilizumab ** le / kapa ** corticosteroids ** e kopantsoeng le setsi sa bona sa phekolo ea cellular.

Mongolo o nepahetseng oa puisano bakeng sa 911/112/999 le Emergency Triage¶

Liphuputso li bonts'a hore bakuli ba mofetše oa neutropenic hangata ba na le tieho e kotsi libakeng tse phetheselang tsa phaposi ea tšohanyetso ntle le haeba mokuli kapa setho sa lelapa se bua mantsoe a kliniki "Chemotherapy Neutropenic Sepsis: Window ea Metsotso e 60 ea Antibiotic" ha motho a qala ho kopana. Sebelisa lentsoe lena la mongolo bakeng sa lentsoe:

• Ha o letsetsa 911/112/999 (haeba ho le teng ho hatsela, ho tsekela, ho hema ka thata, kapa pherekano):

  "Ke hloka ambulense ho [Aterese e Nepahetseng] bakeng sa ho belaelloang hore Neutropenic Sepsis. Mokuli ke [Bomo] ea lilemo li [e motona/motšehali] ea fuoang phekolo ea lik'hemik'hale bakeng sa [Mofuta oa Kankere], ka ho tšeloa ha bona ka chemotherapy ea ho qetela ka [Letsatsi, matsatsi a X a fetileng]. [O] na le mocheso oa [X degrees Celsius / Fahrenheit] o tsamaea le bofokoli bo bokhutšoanyane. pherekano], 'me e kentsoe [sefubeng Port-a-Cath / letsoho PICC line] HA rea fana ka Tylenol leha e le efe kapa ibuprofen."

• Ha u nyolohela Lefapheng la Tšohanyetso la Triage Desk (haeba u fihla ka koloi):

  "Mokuli enoa o sebelisa chemotherapy e sebetsang (Letsatsi la [X] ka mor'a ho kenngoa, ka har'a fensetere ea nadir) 'me o na le Neutropenic Fever ea [X.X°C / XXX.X°F]. Mona ke [hae] Karete ea Tlhokomeliso ea Oncology Neutropenic Sepsis. Tlas'a ASCO, IDSA, le NICE ditataiso tsa ts'ireletso, [he peritephe] Port-a-Cath blood cultures, le thamo ea pele ea lithibela-mafu tse pharalletseng ka har'a methapo nakong ea metsotso e 60 ka mor'a hore motho a qale."*

• Haeba mokuli a sebelisa Immunotherapy (Checkpoint Inhibitors joaloka Pembrolizumab/Keytruda, Nivolumab/Opdivo, kapa Ipilimumab/Yervoy):

  "Tlhaloso ea Bohlokoa Bakeng sa Teko: Mokuli enoa o fumana Kankere Immunotherapy ([Lebitso la Lithethefatsi]), eseng feela phekolo ea meriana ea setso. Matšoao a bona e ka 'na ea e-ba Ketsahalo e Amanang le Immune-Related Adverse (irAE) e kang autoimmune pneumonitis, colitis, myocarditis, kapa adrenal crisis, e hlokang ho buisana le ngaka hang-hang bakeng sa phekolo ea "rticosteroids" tlolo ea molao."*

Seo u ka se tšoarang ka metsotso e 2 bakeng sa Go-Bag ea Lefapha la Tšohanyetso¶

• "Karete ea Tlhokomeliso ea Chemotherapy / Immunotherapy Wallet" ea mokuli (e bontša mokhoa o nepahetseng oa ho sebelisa lithethefatsi, letsatsi la potoloho ea ho qetela, pager ea lihora tse 24 / nomoro ea mohala ea oncologist, le mofuta oa boema-kepe).
• **Karete ea boitsebiso ea Port-a-Cath kapa port fob e kenyang matla ** (e bolella baoki ba tšohanyetso hore na kou ea sefuba ke "Power-Injectable" bakeng sa phapang ea CT scan le hore na nale ea Huber ea boholo [\(3/4\text{-inch}\) vs. \(1\text{-inch}\)] e lekana boema-kepe).
• ** Cream cream (lidocaine/prilocaine EMLA cream)** haeba e laetsoe: ho sebelisa dab ea tranelate e laetsoeng ea ho bala holim'a sefuba sa Port-a-Cath se koahetsoeng ka sekoahelo sa polasetiki ha u ntse u palame koloing ho ea sepetlele ho senya letlalo ka metsotso e 30 kahoo ho kena boema-kepeng ka nale ea Huber ha ho na bohloko.
• Meriana eohle ea hona joale ea lapeng (haholo-holo lithibela-mafu life kapa life tsa prophylactic tse kang levofloxacin kapa trimethoprim-sulfamethoxazole, li-antifungal tse kang fluconazole/posaconazole, li-antivirals tse kang acyclovir, liente tsa kholo joaloka **pegfilgrastim [Neulasta] kapa filgrastim [Neupogen])*, le mali a fokolang mali.
• Chaja ea mohala le maske a hloekileng a sa sebetseng.

Thibelo ea ts'oaetso ea letsatsi le letsatsi nakong ea Chemotherapy Nadir (Matsatsi a 7 ho isa ho a 14)¶

Le hoja ho se na tšireletso e thibelang karolo ea 100 lekholong ea feberu ea neutropenic (hobane mafu a mangata a tsoa limela tse tloaelehileng tsa tšilo ea lijo ea mokuli), ho latela melao ena e thehiloeng bopaki nakong ea matsatsi a tlaase ho fokotsa ho kena sepetlele ho ka thibeloang: 1. Tlhokomelo ea Molomo (Thibela ho Kena ha Mucositis): Hlatsoa molomo oa hau makhetlo a 4 ka letsatsi (ka mor'a lijo tsohle le pele u robala) ka motsoako o bobebe oa **\(1/2\text{ teaspoon}\) letsoai le \(1/2\text{ teaspoon}\) baking soda (sodium bicarbonate) e qhibilihisitsoeng ka \(240\text{ mL}\) (\(8*\)text) ea metsi a futhumetseng. Sebelisa borashe ba meno bo bonolo haholo, 'me u qobe lintho tse hlatsoang melomo ka joala tse omisang le ho pshatla lesela la molomo. 2. Ho Thibela ho Koaheloa le ho Fissure Anal: Kalafo ea lik'hemik'hale le meriana e thibelang ho nyekeloa ke pelo (joaloka ondansetron/Zofran) e baka pipitlelano e matla. Ho tsitlallela ho feta setulong se thata ho tabola lesela le robehang la mohlako (anal fissure), ho theha sebaka se tobileng sa hore libaktheria tsa maleng li kene maling. Nka li-softeners tse khothalelitsoeng ke ngaka ea oncologist pele ho nako, noa maro a mangata, 'me le ka mohla u se ke ua sebelisa li-suppositories kapa enema. 3. Lijo le Bohloeki ba Matsoho: Hlapa matsoho ka sesepa le metsi a futhumetseng metsotsoana e 20 pele u ja le ka mor'a ho sebelisa ntloana. Pheha nama eohle, likhoho, tlhapi le mahe ka botlalo ho isa mochesong o sireletsehileng oa ka hare, hlatsoa litholoana tse tala le meroho ka hloko, ’me u qobe lebese le sa tsoakoang, limela tse tala, likhofu/sushi tse tala le lijo tsa buffet tse lutseng mochesong oa kamore. 4. Utloisisa Pegfilgrastim (Neulasta) Bone Pain vs. True Fever: Bakuli ba bangata ba fumana ente e matlafatsang lisele tse tšoeu tsa mali (pegfilgrastim kapa filgrastim **, G-CSF) lihora tse 24 ka mor'a chemotherapy. Ha moko oa masapo o hlahisa li-neutrophils tse ncha ka tlako matsatsing a 2 ho isa ho a 5 a latelang, bakuli ba atisa ho utloa bohloko bo tebileng ba letheka, lesapo la sefuba, le mokokotlo o ka tlaase (hangata o imoloha ke loratadine [Claritin] haeba e amoheloa ke oncologist). Leha ho le joalo, le ka mohla u se ke ua nahana hore feberu ea \(38.0^\circ\text{C}\) (\(100.4^\circ\text{F}\)) kapa ho feta e tsoa ho "Neulasta shot": hlahloba mocheso oa hau kamehla 'me u letsetse oncology hang-hang bakeng sa feberu efe kapa efe.

Lipotso tse botsoang khafetsa¶

Hobaneng ho nka Tylenol (acetaminophen / paracetamol) kapa ibuprofen bakeng sa feberu e bobebe kapa hlooho e bohloko hakaale nakong ea chemotherapy?¶

Ha chemotherapy e theola lisele tsa hao tse tšoeu tsa mali (li-neutrophils), ’mele oa hao ha o khone ho etsa boladu, bofubelu, kapa ho ruruha sebakeng ha libaktheria li hlasela, kahoo feberu e ntseng e phahama hangata ke eona FEELA letšoao la hore tšoaetso ea mali e sokelang bophelo e qalile. Ho nka acetaminophen, paracetamol, ibuprofen, kapa aspirin ho theola mocheso oa hau ka mokhoa oa maiketsetso ka lihora tse 'maloa ebe ho pata letšoao la temoso ha libaktheria li ikatisa ka potlako maling a hau. Le ka mohla u se ke ua noa meriana leha e le efe e fokotsang feberu nakong ea chemotherapy ntle le ho hlahloba mocheso oa hau pele le ho fumana tumello e hlakileng ho tsoa ho sehlopha sa hau sa oncology.

Ke ho bala hofe ha thermometer ho bohlokoa joalo ka tšohanyetso ea bongaka nakong ea chemotherapy?¶

Ho ea ka litataiso tsa machaba tsa oncology (ASCO, IDSA, le ESMO), tšohanyetso ea feberu ea neutropenic ke mocheso ofe kapa ofe o le mong oa molomo oa 38.3 ° C (101.0 ° F) kapa ho feta, KAPA mocheso oa molomo oa 38.0 ° C (100.4 ° F) kapa o phahameng o nkang hora e feletseng ea 1 (lipetlele tse ngata tsa UK NHS 3 tsa ho bala tse ngata tsa UK NHS 8. 100.4°F). Ho feta moo, haeba mokuli ea phekoloang ka lik’hemik’hale a e-na le mohatsela o sisinyehang, ho tsekela, ho ferekana maikutlo, ho hema ka thata, kapa mocheso o sa tloaelehang o LE TLASE ka tlase ho 36.0°C (96.8°F), ke tšohanyetso ea hang-hang esita le ntle le ’malo o phahameng oa thermometer.

Ke hobane'ng ha litataiso tsa tšohanyetso li thibela ho sebelisa thermometer ea rectal kapa rectal suppository ho mokuli oa chemotherapy?¶

Khemotherapy e tšesaane le ho fokolisa lera le boreleli le potileng lera le mala ha ka nako e tšoanang e theola lisele tse tšoeu tsa mali tse loantšang tšoaetso le liplatelete tse koalang mali. Ho kenya themomete ea rectal, suppository, kapa enema ho ka harola kapa ho tabola lerako le robehileng habonolo, ha kenya limilione tsa libaktheria tsa mala ka ho toba maling (ho bakang lefu le bolaeang la Gram-negative sepsis) le ho baka mali a mangata haholo.

Ke hobane'ng ha bohloko ba morao ho mokuli oa kankere bo hloka tlhahlobo e potlakileng bakeng sa khatello ea mokokotlo oa mokokotlo?¶

Lik'hemik'hale tse ngata tse tloaelehileng (haholo-holo tsa matsoele, prostate, matšoafo, liphio le multiple myeloma) li ka namela masapong a mokokotlo. Haeba lesapo la hlahala le hola ka har'a kanale ea lesapo la mokokotlo, letšoao la pele ho bakuli ba fetang liperesente tse 90 ke bohloko bo bocha kapa bo ntseng bo mpefala ba mokokotlo kapa molala (ho mpefala ha o robetse betheng kapa a khohlela) matsatsi kapa libeke pele maoto a fokola kapa a fokola. Ho tšoara khatello e mpe ea mokokotlo oa mokokotlo kapele ka MRI ea tšohanyetso le tekanyo e phahameng ea IV dexamethasone ha mokuli a ntse a khona ho tsamaea ho boloka bokhoni ba bona ba ho tsamaea le ho boloka taolo ea senya.

Mehloli e hlahlobiloe¶

• American Society of Clinical Oncology (ASCO) le Infectious Diseases Society of America (IDSA, United States): Uutpatient Management of Fever le Neutropenia ho Batho ba Baholo ba Tšoaretsoeng Bolotsana: ASCO le IDSA Clinical Practice Guideline Guideline Update (Taplitz et al., *Journal of Clinical Oncologyal Guide bakeng sa Tšebeliso ea Meriana ea Meriana ea Meriana ea Bongaka *) le ID Bakuli ba Neutropenic ba nang le Kankere * (Freifeld et al.).
• Setsi sa Sechaba sa Bophelo bo Botle le Tlhokomelo e Ntle (NICE, United Kingdom): *Neutropenic Sepsis: Thibelo le Tsamaiso ho Batho ba nang le Kankere * (NICE Clinical Guideline CG151, taelo ea metsotso e 60 ea ho thibela lithibela-mafu) le *Metastatic Spinal Cord Compression ho Batho ba Baholo: Tlhahlobo ea Kotsi, Tlhahlobo ea Tlhahlobo le Tsamaiso ea 2NICE3 *
• European Society for Medical Oncology (ESMO): Taolo ea Febrile Neutropenia: ESMO Clinical Practice Guidelines (Klastersky et al., Annals of Oncology) le * Tataiso ea ESMO mabapi le Tsamaiso ea Chefo e tsoang ho Immunotherapy *.
• ** National Comprehensive Cancer Network (NCCN, United States): ** *NCCN Clinical Practice Guidelines in Oncology: Thibelo le Kalafo ea Likokoana-hloko tse Amanang le Kankere * le * Taolo ea Tšoaetso ea Immune Checkpoint Inhibitor-Related Toxicities *.
• Mokhatlo oa Baoki ba Oncology (ONS) & Mokhatlo oa Baoki oa UK Oncology (UKONS): Acute Oncology Initial Management Guidelines le 24-Hour Triage Rapid Assessment Toolkit.

Litataiso tse amanang¶

• Tsebo ea sepsis le septic shock le karabelo ea tšohanyetso
• Cauda equina syndrome le lifolakha tse khubelu tsa khatello ea mokokotlo oa mokokotlo
• Bothata ba adrenal le ente ea tšohanyetso ea lefu la Addison
• Pulmonary embolism le deep vein thrombosis (DVT)
• Ho tsoa mali ho beha bophelo kotsing ho batho ba fokotsang mali kapa ba nang le hemophilia