Oncology and haematology

Introduction: Over the last few years there has been a trend towards more intensive treatment for paediatric oncology patients. This includes both primary and relapsed disease protocols. The impact of these changes on the usage of intensive care (PIC) and high dependency care (HD) is unclear. Aim: To quantify the changes in PIC and HD usage for oncology patients over the last 3 years. Methods: This hospital houses the only tertiary paediatric oncology unit as well as the only PIC unit for the region. We have reviewed the admissions to our combined PIC/HD unit over the last 3 years. The reason for admission, risk of mortality, length of stay and outcome were recorded. Results: Annual admissions of Oncology patients to the unit increased from 32 in 1999 to 72 in 2001(2.2 fold increase). Bed days over this period increased from 61 to 302 (5 fold increase). The percentage of patients admitted for sepsis rose from 3% to 26%. Mortality on PICU remains quite low at 7% (standardised mortality rate against PIM, 1.04) but a further 5% of patients die within 1 month of discharge. Median length of stay has not changed (1 day for surgical and 2 days for medical patients) however a small number of long stay patients skew the data. In 2001 8 patients (11%) accounted for 59% of bed days. Conclusion: Although many oncology children requiring HD con- tinue to be nursed on a non HD ward, there is a substantial rise in admissions to our PIC unit. This probably reflects the increasing com- plexity of protocols and the rise in treatment of relapsed disease. filtration rate (GFR) to monitor the nephrotoxic effect of drugs or as a basis for drug dosing plays an important role in the management of oncology patients. Measurement of GFR by isotope tracer techniques is regarded as a gold standard but commonly occurring conditions in oncology patients may alter tracer kinetics and lead to inaccuracies of measurement. The aim of this study was to establish if clinically significant errors are made in patients with large solid tumours. Method: Ten newly diagnosed paediatric oncology patients had pre-treatment GFR measured using radiolabelled tracers with an extended sampling technique. This served as a reference technique and was compared to the result obtained using the standard technique of sampling between two and four hours. In eight of these patients measurements were repeated after several cycles of chemotherapy treatment. Results: In all ten patients there were significant deviations of the pattern of tracer plasma clearance from the expected single exponen-tial after two hours. The GFR calculated from the standard technique was significantly higher (median 33%, range 11–44%) than the GFR calculated by the reference technique. In all eight post-therapy patients the clearance more closely approached the expected pattern and the difference between the ref- erence and standard GFR calculations was significantly reduced (median 22%, range –7%–34%). Conclusions: In this group of patients the tracer kinetics were dis-rupted from the expected pattern and this led to clinically significant errors in the standard technique of measuring GFR. This may be due to altered vascularity or changes in permeability due to the disease state. Reductions in measured GFR with treatment require careful interpretation as they may not be due to nephrotoxicity but to reduction of tumour bulk. If accurate assessments of GFR are required for monitoring nephrotoxic effect or for chemotherapy dosing, an extended sampling schedule may be required. Aims: While A and B red cell antigens are determined in Methods: Cord blood samples, and corresponding maternal samples, were taken at birth from Rh D negative women. Red cell groups and antiglobulin testing were performed by routine standard tests. Sera were analysed for both IgG and IgM antibodies by testing for agglutination with ABO cell solutions containing saline with bromelain (necessary for IgG to cause agglutination—presumed maternal antibodies). Positive samples were tested in saline alone; agglutination then would be caused only by the presence of IgM antibodies of fetal origin (because maternal IgM does not cross the placenta). Samples positive in saline only were then titred, the titre being recorded as the reciprocal of the highest dilution giving weak agglutination. Results: 195 cord samples were tested. The red cell groups showed 56% infants to be group O, 34% group A, 8% group B and 2% group AB. 140/195 (72%) serum samples showed reactions in bromelain, but 91 (47%) agglutinated cells in saline only and therefore fetal IgM. babies blood groups group A, 14 and group B, 6 The highest titre of antibodies was 128 (anti- A in a group O infant), and the median titres for anti-A and anti-B 1 and 0. Most had titre agglutinins. normal adult older group anti-A titres at least 8–16 and anti-B titres 4–8).