Oncology diagnosis I could look for...

annnd2009@gmail.com

Hi,
I dont' have much oncology experience other than your run of the mill "pancytopenia due to chemotherapy" and newly learned "due to radiation"...

my patient admitd 3/27 still here. NEWLY diagnoses this admit with: panctopenia due to ALL
the current issues are stated :ALL, + BCR ABL - induction chemo w/ prednisone and dasatinib started Sat 3/29. On allopurinol for tumor lysis.
Pancytopenia- transfusions with irradiated products as needed. On allopurinol and acyclovir prophylaxis.
Neutropenic fever- no infection found - likely due to ALL - has been on cefepime
Groin rash- on lotrimin + nystatin
Abnormal LFT- hepatitis panel neg.
HTN - on atenolol- bp ok
Prediabetes - on SSI with steroids
GERD- was on protonix but changed to pepcid due to interaction w/ dasatinib which is absorbed in an acidic environment
BPH- flomax
FEN: neutropenic diet
PPx: contraindicated with low plts.

Is there anything to look for? The "run of the mills" can't be asked for since the pancytopenia was there BEFORE chemo or radiation..

And the PDX- it would be the ALL right? The induction chemo can't be PDX because it isn't WHY he was admitted - it's what they discovered they needed to do because of the ALL..

Tell me if I am missing something here. Day 25 and no mcc?
Only- ALL,pancytopenia and SIRS due to ALL
Thoughts?

Thanks,
Ann
ann.donnelly@sclhs.net

ssalinas

Perhaps the patiemt has aplastic anemia instead of pancytopenia? I don’t pretend to understand all the intricacies of the various types of anemias but have, on occasion, been able to use aplastic anemia instead of pancytopenia after asking the physician what the difference was and how it was determined. This prompted him to use the term aplastic anemia in the record. If the pancytopenia is due to/with aplastic anemia, then the code for aplastic anemia is used since there is an excludes note under 284.1x. 284.89 is a MCC.



This is from the American Cancer Society website;

Aplastic anemia is a disorder in which the bone marrow fails to make enough blood cells.

The bone marrow is the soft, inner part of bones where the 3 types of blood cells are

made:

· Red blood cells, which carry oxygen to the tissues from the lungs

· White blood cells, which fight infection

· Platelets, which seal damaged blood vessels to prevent bleeding

These cells are made by blood-forming stem cells in the bone marrow. In aplastic anemia,

the stem cells are damaged and there are very few of them. As a result, too few blood

cells are produced. In most cases of aplastic anemia, all 3 types of blood cells are low

(which is called pancytopenia). Rarely, just one of the cell lines, such as red cells, white

cells, or platelets, is abnormal.

Aplastic anemia is not a type of cancer but may be associated with certain cancers

(especially those affecting the bone marrow, such as leukemia) or cancer treatments. A

small number of patients with aplastic anemia may develop leukemia.



There are other references as well in Faye Brown and the CC.





Sharon Salinas, CCS

Barlow Respiratory Hospital

2000 Stadium Way, Los Angeles CA 90026

Tel: 213-250-4200 ext 3336

ssalinas@barlow2000.org

Linda_Rhodes

Hi Ann,
Potential MCC could be tumor lysis syndrome 277.88. This is a potentially fatal complication of tumor necrosis either spontaneously or following chemo. These patients are usually pretty sick with hyperkalemia, hyperphosphatemia, hypocalcemia, acute renal failure. I see this pt is on Allopurinol. Not sure if they exhibited any of the s/sx of this syndrome.
I would also look for potential malnutrition, cachexia, thrush,etc..
Good luck!

Thanks,
Linda




Linda Rhodes RN, BSN, CCDS
Manager Clinical Documentation
Improvement
New Hanover Regional Medical Center
Wilmington, North Carolina 28402
Office # 910-815-5544
Cell " 910-777-8344
e-mail : linda.rhodes@nhrmc.org

"I have a Code for that"
Visit Capsuleslive for more information on ICD-10 implementation

annnd2009@gmail.com

Thanks Linda and Sharon, the patient left but I'm going to pull it and see if I can talk to oncologist to see if it would have been an appropriate question.

Ann