A Spider Bite

A Spider Bite

A Spider Bite A Spider Bite

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Question 1 of 3

1. Question
Following the blood film report, which of the following steps will you consider? (Select all that apply)
- Change Co-amoxiclav to piperacillin-tazobactam
- Add LDH, uric acid and fibrinogen to her bloods
- Dwell NaCl 0.9% with 40 mmol KCL over 6 hours
- Transfuse 2 units of Packed RBCs over 4 hours
- Arrange for leukapharesis
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Question 2 of 3

2. Question
Which of the following is a marker of large volume disease that will increase the risk of developing TLS? (Select all that apply)
- WCC >50×109 cells/L
- HB <90 g/L
- Bulky disease (HSM, lymphadenopathy, mediastinal mass)
- Uric acid >3 mg/dl
- Pre-existing impaired renal function
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Question 3 of 3

3. Question
What should be the next step in management?
- Admit under local medical team for haematology review in the morning
- Discharge after stabilising the patient with a 2WW referral to the haematology team
- Discharge after stabilising the patient with an urgent outpatient appointment to start chemotherapy
- Liaise with the nearest tertiary centre that can provide 24/7 leukapharesis for urgent overnight transfer
- Admit under medical team, arrange for an outpatient leukapheresis with the nearest centre within 48 hours
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