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3.10.5 - Malignant Haematology in Intensive Care
from Section 3.10 - Haematological and Oncological Disorders
- By Jenny O’Nions, William Townsend
Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
Book:

Intensive Care Medicine

Published online:

27 July 2023

Print publication:

01 December 2021, pp 343-352
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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.