Malignant Haematology in Intensive Care

3.10.5 - Malignant Haematology in Intensive Care

from Section 3.10 - Haematological and Oncological Disorders

Published online by Cambridge University Press: 27 July 2023

Jenny O’Nions and

Edited by

Debashish Dutta and

Ned Gilbert-Kawai: Affiliation:
The Royal Liverpool Hospital
Debashish Dutta: Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann: Affiliation:
Royal Berkshire Hospital, Reading

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Summary

Key Learning Points

1. Referral to the ICU should be made, considering the patient’s previous performance score (PS), underlying disease, prognosis and treatment plan, as well as patient wishes. There are no absolute contraindications to ICU admission for haematology patients. A trial of intensive care is usually warranted in patients suitable for life-prolonging therapy.
2. The outcome of ICU admission is largely determined by the acute critical illness, not the underlying haematological malignancy.
3. Patients receiving treatment for haematological malignancies are at high risk of infections and can have immune dysfunction in the absence of cytopenias (recovery of normal neutrophil levels after treatment does not guarantee normal functionality).
4. There are important differences between autologous haematopoietic stem cell transplants and allogeneic HSCT, which impact both complications and prognosis.
5. A tissue biopsy should usually be obtained in patients with suspected haematological malignancy prior to starting steroids. Histological diagnosis is critical in haematological malignancy.

Keywords

haematology malignancy autologous allogeneic

Type: Chapter
Information: Intensive Care Medicine
The Essential Guide
, pp. 343 - 352

DOI: https://doi.org/10.1017/9781108989060 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2021

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References

References and Further Reading

Foot, C, Hickson, L. Leadership skills in the ICU. In: Webb, A, Angus, D, Finfer, S, Gattinoni, L, Singer, M (eds). Oxford Textbook of Critical Care, 2nd edn. Oxford: Oxford University Press; 2016. pp. 64–70.Google Scholar

Intensive Care Society. 2001. Guidelines for the transport of the critically ill adult. Standards and guidelines. www.baccn.org/static/uploads/resources/ICSStandardsTransport.pdf Google Scholar

Lee, DW, Santomasso, BD, Locke, FL, et al. ASTCT consensus grading for cytokine release syndrome and neurologic toxicity associated with immune effector cells. Biol Blood Marrow Transplant 2019;25:625–38.Google Scholar

Matthey, F, Parker, A, Rule, SA, et al. Facilities for the treatment of adults with haematological malignancies – ‘levels of care’: BCSH Haemato-Oncology Task Force 2009. Hematology 2010;15:63–9.CrossRef Google Scholar PubMed

Thachil, J, Hill, Q (eds). Haematology in Critical Care. Oxford: Wiley-Blackwell; 2014.Google Scholar

Townsend, WM, Holroyd, A, Pearce, R, et al. Improved intensive care unit survival for critically ill allogeneic haematopoietic stem cell transplant recipients following reduced intensity conditioning. Br J Haematol 2013;161:578–86.CrossRef Google Scholar PubMed

Wise, MP, Barnes, RA, Baudouin, SV, et al.; British Committee for Standards in Haematology. Guidelines on the management and admission to intensive care of critically ill adult patients with haematological malignancy in the UK. Br J Haematol 2015;171:179–88.Google Scholar