HEMATOLOGICAL MALIGNANCIES IN ICU _ DR SUDIPTA MUKHERJEE TMC KOLKATA/ PROF LALITA G MAITRA CHD

00:00:00 intro
00:03:30 content , febrile neutropenia
00:35:20 invasive fungal infn
00:41:00 hyperleukocytosis, stasis
00:42:50 slide art
00:47:25 CRS cytokine release syndrome
00:53:10 DS diff syndrome
00:57:14 discussion

Neutropenic Sepsis in Hemato-Onc
Dr. Sudipta Mukherjee, Head of Critical Care at Tata Medical Center ONCOLOGY , Kolkata,
Sudipta discussed the management of neutropenic fever, emphasizing the need for risk assessment and appropriate antibiotic selection based on patient factors and local bacterial resistance patterns. She highlighted the importance of distinguishing between new infections and myeloid reconstruction syndrome, which can occur with neutrophil recovery. The discussion also covered common pathogens in neutropenic patients, including gram-negative bacteria prevalent in the Indian context, and the challenges of treating such patients in resource-limited settings.
Sudipta discussed the assessment and management of high-risk and low-risk patients with febrile neutropenia, focusing on clinical features, scoring systems, and diagnostic approaches. She explained that high-risk patients require hospital admission for empirical antibiotics, while low-risk patients can be managed as outpatients. Sudipta emphasized the importance of careful clinical assessment, including site-specific symptoms and antimicrobial prophylaxis history, and highlighted the role of blood cultures and site-specific samples in diagnosis. She also discussed the limitations of biomarkers like procalcitonin and SOFA score in predicting outcomes in neutropenic patients, noting that while they can provide corroborative value, they are not definitive diagnostic tools.
PCR Test
Sudipta discussed the use of PCR-based tests for identifying bacteria and resistant patterns, emphasizing their importance in early diagnosis and streamlining treatment for immunocompromised patients. She highlighted the challenges of interpreting test results, such as distinguishing between colonization and infection, and the need for cautious use of antibiotics. Sudipta also outlined antibiotic prophylaxis options, focusing on antifungal agents like Posaconazole for myeloid leukemia patients, and discussed various types of immunodeficiencies that can affect patient outcomes.
Antimicrobial Therapy Practices in India
Sudipta discussed antimicrobial therapy practices, noting that antibiotic prophylaxis is not commonly used in India due to high bacterial resistance, but antifungal and antiviral prophylaxis are employed for specific patient groups. For empirical antibiotic treatment, Sudipta recommended carbapenems as the first choice for neutropenic patients, particularly those with ESBL producers, and emphasized the importance of broadening antibiotic coverage for unstable patients. Neutropenic Fever Management Guidelines
he outlined the use of gram-positive antibiotics for specific conditions and the importance of monitoring patients closely, particularly those with hemodynamic instability or respiratory complications. Sudipta also addressed the use of antifungal therapy, highlighting the need for empirical treatment in certain situations and the importance of considering preemptive therapy based on risk factors and non-microbiological tests. She concluded by discussing the use of adjuvant therapies like G-CSF and IVIG, noting that while they may not significantly benefit all patients, they can be considered in certain high-risk groups.
Medical Emergencies in Hematology
Sudipta discussed three medical emergencies: leukostasis, cytokine release syndrome, and differentiation syndrome. Leukostasis, a clinical diagnosis of hyperleukocytosis, is associated with high mortality and requires prompt recognition and management, particularly in acute myeloid leukemia patients. Cytokine release syndrome, a systemic inflammatory response often triggered by immunotherapy, can be mild or severe and requires vigilant recognition and management, with IL-6 blockers as a key treatment. Differentiation syndrome, seen in acute promyelocytic leukemia patients undergoing induction therapy, presents with fever, edema, and respiratory distress, and is treated with high-dose dexamethasone and supportive care.
Neutropenic Patients Management in ICUs
he discussed the management e emphasized the importance of identifying underlying pathologies and ruling out infections, monitoring organ function, and avoiding unnecessary antibiotic escalation. Dr. Sudipta also addressed the use of G-CSF, bone marrow aspiration, and coagulation profile cutoffs for invasive procedures. H