Booklet for Hemato-Oncologists
Case 12 (A, B) - Severe hypertension during the late intensification phase
Child, 9 years old, female, affected by SR-ALL. During the late intensification she developed severe (according to WHO criteria) hypertension. She was receiving the second dose of Vincristine and Doxorubicin. She completed the four doses of L-Asparaginase and was continuing with Dexamethasone (DXM).
A - What preventive therapy would you suggest?
1. Discontinue steroids
2. Continue chemotherapy + antihypertensive agents
3. Discontinue any drug+ antihypertensive treatment
4. Give 50% dose of DXM+ antihypertensive treatment
5. Discontinue the chemotherapy and give antihypertensive agents
B - What do you in general consider least appropriate treating a hypertensive patient?
1. If PLT count is low (< 30,000/µl) give PLT transfusion + antihypertensive agents
2. If PLT count is adequate (> 50,000/µl) 50% dose of DXM + no antihypertensive agents
3. If PLT count is low (< 30,000/µl) perform CT scan + fundus oculi either if bleeding or neurological signs are present+ antihypertensive agents
4. If PLT count is normal (> 100,000/µl) keep diet restriction+antihypertensive agent
5. If PLT count is normal (> 100,000/µl) continue with the same chemotherapy + diuretics+ antihypertensive treatment
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