Hämatologische und onkologische Notfälle

Maligne Erkrankungen zählen zu den wesentlichen Treibern der globalen Krankheitslast und betreffen insbesondere ältere Patienten. Für die Akut- und Notfallversorgung ist es daher wichtig, ein Verständnis des Spektrums möglicher Komplikationen zu entwickeln und einen praktikablen Ansatz zur Versorgung dieser Patienten zu entwickeln. Dieser Beitrag gibt einen Überblick über die wichtigsten Komplikationen und Symptome.

Schlüsselwörter

Tumorlysesyndrom - Rückenmarkkompression - Thromboembolie - Einflussstauung - Thrombopenie - Notfallmedizin - Krebserkrankung

• Literatur

• 1 GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: 1204-1222
• 2 Lash RS, Hong AS, Bell JF. et al. Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care. Emerg Cancer Care 2022; 1: 6
• 3 Committee on Improving the Quality of Cancer Care. Addressing the Challenges of an aging Population, Board on Health Care Services & Institute of Medicine. Delivering high-quality Cancer Care: Charting a new Course for a System in Crisis. Washington, DC: National Academies Press USA; 2013
• 4 in der Schmitten J, Rothärmel S, Rixen S. et al. Patientenverfügungen im Rettungsdienst (Teil 2). Notfall Rettungsmed 2011; 14: 465-474
• 5 Zorn M, Domagk D, Auerbauch T. et al. Maligne intestinale Obstruktion. Z Gastroenterol 2010; 48: 264-273
• 6 Jehn CF, Diel IJ, Overkamp F. et al. Management of metastatic bone disease algorithms for diagnostics and treatment. Anticancer Res 2016; 36: 2631-2637
• 7 Maccauro G, Spinelli MS, Mauro S. et al. Physiopathology of spine metastasis. Int J Surg Oncol 2011; 2011: 107969
• 8 Heindel W, Gübitz R, Vieth V. et al. The diagnostic imaging of bone metastases. Dtsch Arztebl Int 2014; 111: 741-747
• 9 Isaac A, Dalili D, Dalili D. et al. State-of-the-art imaging for diagnosis of metastatic bone disease. Radiologe 2020; 60: 1-16
• 10 Shiloh R, Krishnan M. Radiation for treatment of painful bone metastases. Hematol Oncol Clin North Am 2018; 32: 459-468
• 11 Jawad MU, Scully SP. In brief: classifications in brief: Mirels’ classification: metastatic disease in long bones and impending pathologic fracture. Clin Orthop Relat Res 2010; 468: 2825-2827
• 12 Boussios S, Cooke D, Hayward C. et al. Metastatic Spinal cord compression: Unraveling the diagnostic and therapeutic challenges. Anticancer Res 2018; 38: 4987-4997
• 13 Tintinalli’s emergency medicine: a comprehensive study guide, section 18: hematologic and oncologic disorders. In: Tintinalli JE, Stapczynski J, Ma OJ, Yealy D, Meckler GD, Stapczynski JS, Cline DM, Thomas SH. . 9. New York: McGraw Hill; 2019: 1514
• 14 Nater A, Sahgal A, Fehlings M. Management – spinal metastases. Handb Clin Neurol 2018; 149: 239-255
• 15 Lutz ST, Jones J, Chow E. Role of radiation therapy in palliative care of the patient with cancer. J Clin Oncol 2014; 32: 2913-2919
• 16 Sackmann S. Obere Einflussstauung. Pneumologe 2006; 3: 209-215
• 17 Barnes H, McDonald J, Smallwood N. et al. Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness. Cochrane Database Syst Rev 2016; (03) CD011008
• 18 Friedman T, Quencer KB, Kishore SA. et al. Malignant venous obstruction: superior vena cava syndrome and beyond. Semin Intervent Radiol 2017; 34: 398-408
• 19 Timp JF, Braekkan SK, Versteeg HH. et al. Epidemiology of cancer-associated venous thrombosis. Blood 2013; 122: 1712-1723
• 20 Hach-Wunderle V, Gerlach H, Konstantinides S. Interdisziplinäre S2k-Leitlinie: Diagnostik und Therapie der Venenthrombose und der Lungenembolie; AWMF-Registernummer 065–002. Stand 14.02.2023, gültig bis: 13.02.2028 2023 Zugriff am 28. August 2023 unter: https://register.awmf.org/de/leitlinien/detail/065–002
• 21 Wells PS, Owen C, Doucette S. et al. Does this patient have deep vein thrombosis?. JAMA 2006; 295: 199-207
• 22 Bhatt M, Braun C, Patel P. et al. Diagnosis of deep vein thrombosis of the lower extremity: a systematic review and meta-analysis of test accuracy. Blood Adv 2020; 4: 1250-1264
• 23 Strijkers RHW, Cate-Hoek AJT, Bukkems SFF. et al. Management of deep vein thrombosis and prevention of post-thrombotic syndrome. BMJ 2011; 343: d5916
• 24 Martin KA, Beyer-Westendorf J, Davidson BL. et al. Use of direct oral anticoagulants in patients with obesity for treatment and prevention of venous thromboembolism: Updated communication from the ISTH SSC Subcommittee on Control of Anticoagulation. J Thromb Haemost 2021; 19: 1874-1882
• 25 Geldhof V, Vandenbriele C, Verhamme P. et al. Venous thromboembolism in the elderly: efficacy and safety of non-VKA oral anticoagulants. Thromb J 2014; 12: 21
• 26 Prandoni P, Noventa F, Quintavalla R. et al. Thigh-length versus below-knee compression elastic stockings for prevention of the postthrombotic syndrome in patients with proximal-venous thrombosis: a randomized trial. Blood 2012; 119: 1561-1565
• 27 van Es N, Le Gal G, Otten HM. et al. Screening for occult cancer in patients with unprovoked venous thromboembolism: a systematic review and meta-analysis of individual patient data. Ann Intern Med 2017; 167: 410-417
• 28 Mathis G, Blank W, Reissig A. et al. Thoracic ultrasound for diagnosing pulmonary embolism: a prospective multicenter study of 352 patients. Chest 2005; 128: 1531-1538
• 29 Konstantinides SV, Meyer G, Becattini C. et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41: 543-603
• 30 Gibson NS, Sohne M, Kruip MJ. et al. Further validation and simplification of the Wells clinical decision rule in pulmonary embolism. Thromb Haemost 2008; 99: 229-234
• 31 Weitz JI, Fredenburgh JC, Eikelboom JW. A Test in context: D-dimer. J Am Coll Cardiol 2017; 70: 2411-2420
• 32 van der Hulle, Cheung WY, Kooij S T. et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017; 390: 289-297
• 33 Meyer G, Vicaut E, Danays T. et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2017; 370: 1402-1411
• 34 Becattini C, Agnelli G, Lankeit M. et al. Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model. Eur Respir J 2016; 48: 780-786
• 35 Fanchini M, Marano G, Mengoli C. et al. Red blood cell transfusion policy: a critical literature review. Blood Transfus 2017; 15: 307-317
• 36 Kremer Hovinga JA, Coppo P, Lämmle B. et al. Thrombotic thrombocytopenic purpura. Nat Rev Dis Primers 2017; 3: 17020
• 37 Griesshammer M, Kvasnicka HM, Koschmieder S. Essenzielle Thrombozythämie und Polycythaemia vera. Onkologie 2023; 29: 296-304
• 38 Bug G, Anargyrou K, Tonn T. et al. Impact of leukapheresis on early death rate in adult acute myeloid leukemia presenting with hyperleukocytosis. Transfusion 2007; 47: 1843-1850
• 39 Stewart AF. Hypercalcemia Associated with Cancer. N Engl J Med 2005; 352: 373-379
• 40 Ahmad S, Kuraganti G, Steenkamp D. Hypercalcemic crisis: a clinical review. Am J Med 2015; 128: 239-245
• 41 Berardi R, Torniai M, Lenci E. et al. Electrolyte disorders in cancer patients: a systematic review. J Cancer Metastasis Treat 2019; 5: 79
• 42 Spasovski G, Vanholder R, Allolio B. et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 2014; 29 (Suppl. 02) i1-i39
• 43 Pizzo PA. Management of Patients with fever and neutropenia through the arc of time: a narrative review. Ann Intern Med 2019; 170: 389-397
• 44 Kochanek M, Schalk E, von Bergwelt-Baildon M. et al. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2019; 98: 1051-1069
• 45 Howard SC, Jones DP, Pui C-H. The tumor lysis syndrome. N Engl J Med 2011; 364: 1844-1854
• 46 Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol 2004; 127: 3-11
• 47 Coiffier B, Altman A, Pui C-H. et al. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol 2008; 26: 2767-2778
• 48 Davidson MB, Thakkar S, Hix JK. et al. Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Am J Med 2004; 116: 546-554
• 49 Postow MA, Sidlow R, Hellmann MD. Immune-related adverse events associated with immune checkpoint blockade. N Engl J Med 2018; 378: 158-168
• 50 Arnaud-Coffin P, Maillet D, Gan HK. et al. A systematic review of adverse events in randomized trials assessing immune checkpoint inhibitors. Int J Cancer 2019; 145: 639-648
• 51 Martins F, Sofiya L, Sykiotis GP. et al. Adverse effects of immune-checkpoint inhibitors: epidemiology, management and surveillance. Nat Rev Clin Oncol 2019; 16: 563-580
• 52 Schneider BJ, Naidoo J, Santomasso BD. et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO Guideline Update. J Clin Oncol 2021; 39: 4073-4126
• 53 Haanen J, Carbonnel F, Robert C. et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33: 1217-1238
• 54 Wright JJ, Powers AC, Johnson DB. Endocrine toxicities of immune checkpoint inhibitors. Nat Rev Endocrinol 2021; 17: 389-399
• 55 Jordan K, Chan A, Gralla RJ. et al. 2016 Updated MASCC/ESMO consensus recommendations: Emetic risk classification and evaluation of the emetogenicity of antineoplastic agents. Support Care Cancer 2017; 25: 271-275
• 56 Jordan K, Gralla R, Jahn F. et al. International antiemetic guidelines on chemotherapy induced nausea and vomiting (CINV): content and implementation in daily routine practice. Eur J Pharmacol 2014; 722: 197-202