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