Review of Hematology-Oncology Emergencies for Internal Medicine Residents.

The prevalence of cancer continues to grow globally every year. With therapeutic advances over the recent decades, the prevalence of individuals living with cancer continues to increase. Internal medicine residents can see patients admitted to the hospital for cancer-related emergencies. Early identification and appropriate management of these emergencies have been shown to improve mortality and morbidity. In this article, we aim to review the recent updates in the management of commonly encountered oncologic emergencies in the practice of internal medicine residents. This review will cover spinal cord compression, superior vena cava syndrome, tumor lysis syndrome, hypercalcemia, pericardial tamponade, hypoglycemia, hyponatremia, bowel obstruction, increased intracranial pressure, leukostasis, hyperviscosity syndrome, neutropenic fever, and hypersensitivity reactions.

Synchronous development of prostate sarcoma and squamous cell carcinoma following radiotherapy.

With the development of more sensitive screening tools, malignancies are being diagnosed at an earlier stage, resulting in earlier intervention and longer survival times. As a consequence, the long-term complications of cancer therapy are increasing in incidence, particularly second primary cancers from radiation therapy. Bladder and colorectal cancers are the most commonly reported malignancies secondary to radiation therapy for prostate cancer. We present the case of a 78-year-old patient with a remote history of prostate adenocarcinoma, status post brachytherapy, who subsequently developed both prostate sarcoma and prostate squamous cell carcinoma secondary to the prior treatment. Because his cancer was metastatic, he was not a candidate for surgery and was treated with chemotherapy and palliative radiation.

Association of acute thrombocytopenia with anaphylaxis.

A commonly seen phenomenon in the hospital and critical care setting is anaphylaxis. This acute systemic inflammatory reaction can lead to anaphylactic shock in severe cases and potentially be fatal. The role of platelets in anaphylactic reactions is not well established; however, platelets, among other mediators such as platelet-activating factor, have been shown to promote a prothrombotic state shortly after an acute hypersensitivity reaction. In addition, the aggregation of platelets promoted by platelet-activating factor and other mediators can also lead to thrombocytopenia. We present a case of a 57-year-old woman who developed severe anaphylaxis while receiving chemotherapy with paclitaxel suspended in Cremophor, a well-known allergen. She was profoundly thrombocytopenic following the reaction and was treated with therapeutic anticoagulation, with no thrombus formation.

Exploring the Rare Etiology of Severe Anemia in an Immunocompromised Patient.

Pure red cell aplasia (PRCA) is a rare cause of profound anemia, marked by very low reticulocyte count and near to complete absence of erythroid precursor cells in the bone marrow. PRCA can be congenital such as in the case of children with Diamond- Blackfan anemia or acquired, which is often triggered by exposure to certain viruses or drugs. Management depends on the underlying etiology of PRCA. Here, we present the case of a young male with underlying acquired immunodeficiency syndrome, who presented with a hemoglobin of 2.6 g/dL, initially thought to be secondary to gastrointestinal blood loss, but was later discovered to have parvovirus-induced PRCA.

Treatment of Refractory Lactic Acidosis With Thiamine Administration in a Non-alcoholic Patient.

Lactate, or lactic acid, is an end-product of anaerobic metabolism. The build-up of lactate in the body is commonly due to type A lactic acidosis, resulting from an inability to meet the body's oxygen delivery demands. When lactic acidosis persists, other causes need to be ruled out. Here, we describe the case of a 63-year-old female who initially presented with hypoglycemia and was found to have significant lactic acidosis. Her blood sugar levels improved with dextrose supplementation; however, lactic acidosis persisted despite fluid hydration and empiric antibiotics. After excluding other causes of lactic acidosis, she was started on intravenous thiamine due to suspicion of thiamine deficiency secondary to poor nutrition. Lactic acid levels improved drastically after starting thiamine supplementation. Thiamine is a water-soluble vitamin that plays an essential role as a cofactor in several biochemical reactions. Thiamine deficiency is a rare, underdiagnosed cause of type B lactic acidosis, with early diagnosis and intervention playing crucial roles in preventing severe cardiac and neurological impairment.

Rapid Development of Pernicious Anemia Unmasking Underlying Gastric Adenocarcinoma.

Gastric cancer is one of the most common malignancies, often detected at later stages as patients remain asymptomatic until later stages. Pernicious anemia (PA), a well-known cause of vitamin B12 deficiency, is a classic risk factor for gastric cancer. Patients with PA usually present with megaloblastic anemia and peripheral neuropathy; however, they can also present with nonspecific symptoms. We describe below the case of a 56-year-old male who presented with symptoms of nausea, vomiting, and fatigue. Initial lab work revealed severe B12 deficiency, pancytopenia, and intramedullary hemolysis warranting endoscopy that revealed a gastric fundus mass significant for adenocarcinoma on biopsy.

A Case Report on Bortezomib-Induced Bilateral Chalazion.

A chalazion is a swollen bump on the eyelid that occurs when the eyelid's oil gland clogs up. Bortezomib is an FDA-approved novel agent for the treatment of patients with multiple myeloma (MM). Recently, there have been a few case reports on the possible association between eyelid chalazion and bortezomib therapy. We describe the case of an 87-year-old female diagnosed with MM who developed bilateral eye chalazion after being initiated on bortezomib. She was evaluated by an ophthalmologist, started on eye lubricants and antibiotic eye drops, and the bortezomib was discontinued until the resolution of the lesions was achieved. Physicians should be aware of these ocular complications of bortezomib, as early intervention can prevent worsening eyelid complications.

Organ donation education in the ICU setting: a qualitative and quantitative analysis of family preferences.

PURPOSE: Determine family-centered methods of providing organ donation education to families in ICU waiting rooms. MATERIALS AND METHODS: We performed a qualitative analysis of semi-structured interviews and quantitative analysis of paper surveys of family members of 118 ICU patients in the acute ICU setting. RESULTS: Twelve interviews and 152 surveys (66% response rate) were completed. Respondents' knowledge of organ donation processes was incomplete: only 32% answered all of four questions about donation correctly. No significant correlation was found between respondents' objective knowledge scores and their self-reported donation knowledge (ρ = 0.07, p = .46). Seventy-five percent of respondents (110/147) thought receiving donation information during the ICU stay would aid their decision-making regarding donation. The most preferred methods of receiving information were via a website link (94% positive or neutral response) or brochures in the waiting room (89% positive or neutral), while the least preferred methods were having brochures in the ICU admission packet (24% negative) and a poster in the ICU waiting room (22% negative). CONCLUSIONS: ICU families desire accurate information about organ donation, and are receptive to its provision in the acute ICU setting. Family-centered approaches to information delivery may enhance understanding of organ donation processes and aid decision-making about organ donation.