Page 181 - Essential Haematology

Chapter 12 Haematological malignancy: management / 167

The treatment of haematological malignancy has Blood product support (see Chapter 29 )
improved greatly over the last 40 years. Th is has
Red cell and platelet transfusions are used to treat
resulted from developments in supportive therapy
anaemia and thrombocytopenia. A number of par-
and in specifi c treatment . Details of specifi c treat-
ticular issues apply to the support of patients with
ment are discussed in relation to individual diseases
haematological malignancy:
in the appropriate chapter. Support care and general
aspects of the agents used in the treatment of hae- 1 The threshold haemoglobin for transfusion will

matological malignancy are described here. depend on clinical factors such as symptoms and
speed of onset of anaemia but most units give red
cell support for a Hb < 8 g/dL, with a higher
General s upport t herapy
threshold in older patients. In patients needing
Patients with haematological malignancies often both red cells and platelets, platelets are given
present with medical problems related to suppres- first to reduce the risk of a further fall in the

sion of normal haemopoiesis and this problem is platelet count.

compounded by the treatments that are given to 2 The trigger for platelet transfusion is typically a
9
eradicate the tumour. General supportive therapy platelet count < 10 × 10 /L but this should be
for bone marrow failure includes the following. doubled in the presence of active bleeding or
infection.

3 Fresh frozen plasma (FFP) may be needed to

Insertion of a central venous catheter
reverse coagulation defects.
A central venous catheter is usually inserted prior 4 Cytomegalovirus (CMV) negative blood should
to intensive treatment via a skin tunnel from the be given to all patients until it has been shown
chest into the superior vena cava (Fig. 12.1 ). Th is that they are either CMV seropositive or that
gives ease of access for administering chemotherapy, they will never be candidates for stem cell trans-
blood products, antibiotics and intravenous feeding. plantation (SCT). This is to prevent transmission

In addition, blood may be taken for laboratory tests. of CMV to uninfected patients as the virus is a

(a) (b)

Figure 12.1 (a) A central venous line in a patient undergoing intensive chemotherapy. (b) Chest X - ray showing

correct placement of a central venous line, in this case a tunnelled triple lumen left internal jugular line.
(Courtesy of Dr P. Wylie.)