nursing-practice-neonatology-2019-scientifictracks

6 / 8

Page 24
December 09-10, 2019 | Barcelona, Spain
Nursing Practice 2019 & Neonatology 2019
December 09-10, 2019
Nursing and Nursing Practice Neonatology and Perinatology
7th Global Experts Meeting on 4th World Congress on
ISSN: 2632-251X | Volume 3 Journal of Nursing Research and Practice
J Nurs Res Pract, Volume 3
Anthracycline induced early cardiotoxicity in a very young Omani patient with Acute
Myeloid Leukemia
Surekha Tony
Oman Medical Association, Oman
Background: Anthracycline-cardiomyopathy is of concern in children treated for acute myeloid leukemia (AML) as it may be
progressive and fatal. It can present as early cardiac dysfunction with onset during or after chemotherapy.
Objective: We aim to highlight the risk of early-onset cardiotoxicity with a low cumulative anthracycline dose in a child with AML
with concurrent sepsis.
Material and Methods: Two-year old Omani boy with AML-M7 with complex karyotype, baseline echocardiography anatomically
normal heart with left ventricular ejection fraction (LVEF) 55-60% was planned for chemotherapy. He was initiated on antibiotics
(febrile neutropenia guidelines) for high grade fever. Septic work-up was unremarkable, chemotherapy was initiated in second week.
Repeat echocardiography revealed no vegetation and an LVEF of 55%. By end of second week, chemotherapy was continued.
After second dose of daunorubicin, patient developed tachycardia, tachypnea, respiratory distress, desaturation with a brief seizure
terminating in bradycardia and hypotension requiring resuscitation and ventilation. He had LVEF of 30%, was hypertensive, milrinone,
dobutamine were initiated, later shifted to frusemide, spironolactone and captopril; digoxin was added as cardiac function remained
depressed. Remainder of daunorubicin was skipped. Post-induction BMA revealed remission. Patient received three more courses of
anthracycline-free chemotherapy. Prior to course three chemotherapy, patient had another cardiac arrest. Echocardiography one month
later revealed global dyskinesia and LVEF of 40-45%. Patient is on regular cardiac monitoring, currently on frusemide, spironolactone,
captopril and digoxin at six months follow-up.
Results: Refer Table 1
Conclusion: We conclude that in presence of other known risk factors for cardiac dysfunction like severe sepsis, there is probably no
risk-free dose of anthracycline; decline in cardiac function may occur early in therapy even after a small cumulative dose requiring
close monitoring of cardiac status during chemotherapy. Association of other risk factors need to be explored by evaluation of larger
cohort of such patients.
Biography
Surekha Tony graduated in medicine in 1995 and specialized in pediatrics with training in hematology in Bangalore, India. She is staff
pediatric haemato-oncologist in the Hematology/Oncology Unit at the Department of Child Health, Sultan Qaboos University Hospital
Muscat Oman with an active clinical practice for patients with benign and malignant hematological disorders including bone marrow
transplantation. She has particular interest in thalassemia and has worked as principal and co-investigator in clinical trials. She has
authored and co-authored numerous abstracts and manuscripts and has been active as invited speaker at national and international
conferences. She is actively involved as trainer and examiner for junior-senior clerks and pediatric residents. She is a member of the
Oman Medical Association, Oman Society of Hematology and the Oman Medical Specialty Board.
Baseline For vegetation 1st arrest Pre 2nd arrest 2nd arrest Follow-up at 3 months Follow- up at 6 months
LVIDd 42 42 50 50 48 45 45
LVIDs 30 31 42 39 38 36 35
FS 29 28 14 23 19 21 22
EF 56 55 30 45 37 43 45
MR Trivial Trivial Mild+ Mild Mild+ Trivial Trivial
AR Nil Nil Mild Mild Mild Trivial Trivial