BUMC Basics.pdf - Anesthesia Home

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7. Serum and urine lysozyme (may be useful in cases with
monocytic features)
8. HLA Class I & II DNA-SBT— if patient candidate for
allogeneic HSCT
9. HSV IgM/IgG serologies
10. Coagulation studies to rule out DIC including PT, PTT,
fibrinogen, and D-dimer
11. Lumbar puncture to assess cytology and administer
chemotherapy for all ALL patients (sanctuary sites) and for
AML patients with symptoms of CNS dysfunction
Make sure your patient has the following:
1. Central access via TLC (subclavian preferable for
patient comfort but a non-compressible site) or PICC line
by IV services (may refuse if platelets below their
threshold-usually 50K, but can transfuse platelets in
preparation of PICC)
2. Preserved left ventricular systolic function as confirmed
by TTE or MUGA scan before use of anthracyclines.
3. Aggressive bicarbonate-containing IVFs to alkalinize the
urine and prevent uric acid nephropathy from tumor lysis
(Generally D5W in 1/2NS with 2 amps HCO3 @ 150
cc/hour)
4. Allopurinol 300 mg PO BID +/- rasburicase also for TLS
prophylaxis
5. Prophylactic antimicrobials, typically in the form of
Levaquin 500 mg PO daily, Posaconazole 200 mg PO
TID, and Famvir 250 mg PO BID (If HSV IgG/IgM+) once
ANC approximately 500-1000
6. Orders for daily weights and strict I/O’s (many chemo
regimens have a large volume and need to watch for signs
of volume overload)
7. Orders for daily CMP and CBC
8. Orders for daily TLS labs initially including potassium,
uric acid, LDH, phosphorous, and calcium