Paediatric Haematology & Oncology: Supportive Care Protocols Version: 4th Edition version 2.0 (2018) Summary of Changes for v2.0 Date: 19th October 2018 Previous editions First edition: 2003 Second edition: 2007 Third edition: 2011 (Supportive Care Protocol version 5.0 August 2011) 4th edition v1.0: 2014 A collaborative publication from Great Ormond Street Hospital for Children NHS Foundation Trust The Royal Marsden NHS Foundation Trust University College London Hospitals NHS Foundation Trust Jump to Contents Summary of Changes Abbreviations Quick search: hover cursor over selection in Contents, and click the link to jump to correct page, this will facilitate your search. Any text in blue is also clickable. Table of Contents TABLE OF CONTENTS .................................................................................................................................................... 2 TELEPHONE / FAX NUMBERS AND EMAIL ADRESSES .................................................................................................... 7 GREAT ORMOND STREET CHILDREN’S HOSPITAL ......................................................................................................................... 7 THE ROYAL MARSDEN HOSPITAL ............................................................................................................................................ 10 UCLH CHILDREN AND YOUNG PEOPLE’S CANCER SERVICES ......................................................................................................... 11 ABBREVIATIONS ..........................................................................................................................................................13 LEAD AUTHORS AND CONTRIBUTORS .........................................................................................................................14 1. FORWARD & SUMMARY OF SIGNIFICANT CHANGES ...............................................................................................18 1.2 SUMMARY OF SIGNIFICANT CHANGE BETWEEN SCP 4TH EDITION V2.0 AND V1.0 (WHERE POSSIBLE CHANGES ARE HIGHLIGHTED IN YELLOW IN BODY OF PROTOCOL)............................................................................................................................................. 20 1.3 SUMMARY OF SIGNIFICANT CHANGE BETWEEN SCP 4TH EDITION V1.0 AND PREVIOUS 3RD EDITION (SUPPORTIVE CARE PROTOCOL VERSION 5.0 AUGUST 2011) ................................................................................................................................................ 24 2. USE OF BLOOD COMPONENTS AND HAEMATOPOIETIC CYTOKINES.........................................................................27 GENERAL INFORMATION ....................................................................................................................................................... 27 SPECIAL REQUIREMENTS ....................................................................................................................................................... 28 Irradiated blood components .................................................................................................................................... 28 CMV negative components ........................................................................................................................................ 29 INDIVIDUAL BLOOD COMPONENTS ......................................................................................................................................... 30 Red blood cells ........................................................................................................................................................... 30 Platelets ..................................................................................................................................................................... 31 Platelet Transfusion Guidelines ................................................................................................................................. 32 Fresh Frozen Plasma (FFP) ......................................................................................................................................... 33 Octaplas ..................................................................................................................................................................... 33 Cryoprecipitate .......................................................................................................................................................... 34 Fibrinogen concentrate .............................................................................................................................................. 34 Major haemorrhage .................................................................................................................................................. 35 Granulocytes .............................................................................................................................................................. 35 HAEMATOPOIETIC CYTOKINES ................................................................................................................................................ 36 Granulocyte Colony Stimulating Factor (GCSF) .......................................................................................................... 36 Thrombopoietin Receptor Agonists (TPO-RA) ............................................................................................................ 36 Erythropoietin ............................................................................................................................................................ 36 3. NEUTROPENIC SEPSIS / FEBRILE NEUTROPENIA .......................................................................................................38 3.1 INTRODUCTION ...................................................................................................................................................... 38 3.2 DEFINITION OF “NEUTROPENIC SEPSIS” ...................................................................................................................... 38 3.3 DEFINITION OF RISK: TABLE 1: CRITERIA EXCLUDING PATIENTS FROM LOW RISK PROTOCOL ................................................... 39 3.4 FLOW DIAGRAM / SUMMARY OF THE EMERGENCY MANAGEMENT .................................................................................... 40 3.5 TABLE 2: ASSESSMENT OF PATIENTS WITH NEUTROPENIC SEPSIS ...................................................................................... 41 3.6 EMPIRICAL ANTIBIOTIC TREATMENT OF NEUTROPENIC SEPSIS ........................................................................................... 42 3.6.1 All patients (empirical antibiotics) ............................................................................................................ 42 3.6.2 Patients with suspected Gram positive infection ...................................................................................... 43 3.6.3 Patients at risk of renal impairment ......................................................................................................... 44 3.7 GOSH PATIENTS ONLY (NOT UCLH / RMH) WITH MITOCHRONDRIAL A1555G MUTATION OR WHERE RESULT UNKNOWN ....... 45 3.8 ONGOING MANAGEMENT (48 HOURS ASSESSMENT) ..................................................................................................... 46 3.8.1 Low Risk Neutropenic Sepsis: .................................................................................................................... 46 Management of low risk patients after 48 hours intravenous antibiotic treatment ......................................... 46 Follow up for patients discharged on oral antibiotics after 48 hours ................................................................ 46 3.8.2 Standard risk neutropenic sepsis: ............................................................................................................. 47 3.9 ONGOING MANAGEMENT (STANDARD RISK PATIENTS AFTER 96 HR INTRAVENOUS ANTIBIOTIC TREATMENT IF PERSISTENT FEVER) .. 48 3.9.1 Fungal infections. ...................................................................................................................................... 48 3.9.2 Standard risk patients with persistent fever (> 7 days) ............................................................................ 49 SCPs - 4th Edition Version 2.0 (2018) Table of Contents Oct 2018 PAGE 2 Jump to Contents Summary of Changes Abbreviations Quick search: hover cursor over selection in Contents, and click the link to jump to correct page, this will facilitate your search. Any text in blue is also clickable. 3.9.3 Standard risk patients - duration of intravenous antibiotic therapy ....................................................... 49 3.9.4 Discharge of Standard risk patients ......................................................................................................... 49 3.10 FEBRILE NON-NEUTROPENIA PROTOCOL: TREATMENT OF FEVER IN PATIENTS WITHOUT NEUTROPENIA ......................... 50 3.11 APPENDIX: NEUTROPENIA SEPSIS: EMPIRICAL ANTIMICROBIAL CHOICES ........................................................... 52 3.12 REFERENCES .......................................................................................................................................................... 53 4. PREVENTION AND TREATMENT OF SPECIFIC INFECTIONS AND VACCINATIONS