DEMO Question 2
You are urgently called to the infusion chair side of a patient undergoing hematopoietic stem cell mobilization for evaluation of uncontrolled painful muscle spasms of the upper extremities and perioral numbness and tingling. This is a 57-year-old patient, weighing 78 KG, with multiple myeloma who is on his sixth day of GCSF 780 micrograms SC daily for stem cell mobilization, and is on his second day of 2.5* total blood volume (TBV)/day apheresis with a target CD34 + cell dose collection of 4*10^6CD34+ cells/KG. His cell yield from yesterday's procedure was 3*10^6CD34+ cells/KG, and he had significant nausea following collection yesterday. He has been on the apheresis machine for three hours today prior to symptom onset. He is mildly tachycardic and systolic blood pressure is 15 mmHg lower than baseline pre apheresis BP.
What are your next Rx steps?
- Stop apheresis
- Reassure and complete planned 2.5 TBV apheresis for today
- Stop apheresis and administer IV Calcium gluconate
- Administer Potassium chloride IV
- Give IV Sodium chloride bolus