LABORATORY TESTING FOR PATIENTS UNDERGOING MYELOABLATIVE CHEMOTHERAPY
  1. All standing orders should be reviewed at least weekly
  2. For patients with evidence of or at risk for tumor lysis
    1. electrolytes, phosphate, creatinine, Ca++ q 12 h
    2. uric acid, LDH q day
    3. continue monitoring until stable and past period of maximal cell kill
  3. For patients with M3/APML or with evidence of DIC
    1. Daily PT/INR, fibrinogen, alpha2-antiplasmin, D-dimer
    2. aPTT, antithrombin, plasminogen, fibrin monomer q 3 days
    3. Continue monitoring until DIC subsides and past period of maximal cell kill (renew lab orders q 3 days after first week)
  4. For transfusion management
    1. Daily Hgb
    2. Daily platelet count when previous count < 100,000; QOD platelet count when previous count > 100,000
    3. Platelet count within 1 hour of all platelet transfusions. If patient has poor response ( 10K increase in platelet count) to transfusion; calculate corrected platelet count increment.
  5. For monitoring response to therapy/marrow recovery
    1. WBC >1000: WBC and ANC (differential optional) q.d. after chemotherapy until WBC < 1000
    2. WBC 400-1000: WBC and ANC and scan for blasts (no differential) q day
    3. WBC < 400: WBC q day, ANC q 2-3 days
    4. When WBC begins to rise: daily WBC and ANC (differential optional) until discharge
  6. Fluid and electrolyte management
    1. Daily electrolytes, creatinine, Mg++ (chem 6)
    2. LDH, AST, alk phos, GGT, glucose, total bili, albumin, Ca++, phosphate q 3-4 days
  7. PA/lateral Chest X-ray (in radiology department, not bedside) at least weekly when ANC < 500
  8. Blood cultures


Reviewed January 2005