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A practical handbook of haematology in critical care: Part 2

(BQ) Continued part 1, part 2 of the document A practical handbook of haematology in critical care has contents: Neonatal anaemia, approach to thrombocytopenia, haematological emergencies, multiple myeloma and hyperviscosity syndrome, and other contents. Invite you to refer. | 5 SECTION 5 Approach to White Cell Problems 20 CHAPTER 20 Infectious Complications in the Immunosuppressed Patient Tim Collyns1 and Elankumaran Paramasivam2 1 Leeds Teaching Hospitals Trust St James s University Hospital Leeds UK 2 St James s University Hospital Leeds UK Introduction Patients with many haematological disorders have an increased susceptibility to infections. This may be due to disruption of the patient s host defences by the underlying condition and or the subsequent haematological treatment. Some examples are listed in Table 20.1 however the spectrum of infectious diseases which may be involved varies with the type and severity of the haematological condition and the associated therapy 1-3 . It is also related to the infectious agents which are circulating in the patient s surrounding environment and community and to which they have been exposed to. Depending on the haematological disease patients may present with more than one infectious complication either concurrently or consecutively. Patients may require critical care level support due to the systemic sequelae of an infection or they may acquire certain infections while in the critical care environment. This chapter outlines some of the more common scenarios in the critical care setting and approaches to their diagnosis and successful management. Infectious complications contribute significantly to the overall morbidity and mortality of haematological diseases hence there will usually be local guidelines in place which should be consulted as required. Neutropenic fever This is the archetype of an infectious complication in the setting of haematological diseases. Standard internationally applied definitions are available Table 20.2 but there may be local variation in interpretation of both neutropenia and fever 1 2 4 . Diagnostic criteria for assessing sepsis severity are also outlined in Table 20.2 5 6 . The National Institute for Health and Clinical Excellence NICE in the UK has recently .