BUMC Basics.pdf - Anesthesia Home

Timeline*:
75
Day 0 (admit) — Bone marrow biopsy and other
evaluations
Day 1 — Induction chemotherapy with “7+3” (cytarabine &
idarubicin/daunorubicin) written by Heme-Onc attending
Day 10 to 14 — Bone marrow biopsy #2 to evaluate for
aplasia; G-CSF if no blasts to recover neutrophils
Day 30 (as outpatient) — CBC and Bone marrow biopsy
#3 to assess for complete remission (CR); CR = clean
bone marrow in the setting of no peripheral cytopenias;
CR does NOT equal cure, therefore, induction
chemotherapy if successful, must always be followed by
consolidation therapy (occurs at later admission)
*The above timeline roughly represents a routine
admission for an acute leukemic patient. Obviously, there
will be variation and numerous exceptions depending
upon whether or not remission was achieved, tolerance of
chemotherapy, infectious issues, etc. Intended for
simplified overview only. Day to day supportive care
issues omitted.
Fever in the acute leukemic:
In general, you want to be sure to do the following:
• Examine the patient
• Blood cultures x2
• Fungal culture
• UA and Urine culture
• Sputum culture if cough
• CXR
• Advance antibiotics: typically with first fever, we advance
from levaquin to vancomycin and merrem. The second
time the patient fevers, we advance from posaconazole to
voriconazole. If they continue to fever, you can consider
adding micafungin but will likely need ID involvement.
Most attendings have a preference that they will specify
for antibiotic advancement. Also, if there is a defined
etiology, obviously treat appropriately with antibiotics.