Infection is the most serious complication in cases of acute leukemia. Infection in general, accounts for approximately 70 per cent of the symptoms and as subsequent cause of death in patients with acute leukemia.
Substantial advances have been made over the last decade in the prevention and treatment of infection in cancer patients. Different types of infection occur as a result of abnormalities in post-defense mechanisms. Patients with diminished leukocytes in the blood (granulocytopaenia), are likely to develop infection with gram-negative bacilli such as S. Aureus.
Role of Antibiotics
Treatment with broad spectrum antibiotics is usually helpful. Susceptibility of the infecting organism to the antibiotics and subsequent increase in leukocyte counts, are indicators of good prognosis.
Role of Blood Transfusion
The newer, more effective anti-cancer drug regimens that have evolved for the treatment of both leukemia and other cancers cause substantial bone marrow suppression.
The use of these treatment regimens, many a time, needs whole blood or granulocyte transfusion as a supportive measure. This has proved very helpful in the treatment of acute leukemia with significantly better results. Prophylactic white blood cell (granulocyte) transfusions can even prevent serious infection in granulocytopenic patients. Numerous reports have described groups of patients with serious infection not improving on antibiotic therapy, which have resolved with the addition of granulocytic transfusions.
Granulocyte transfusion is also indicated if the patient has a severe infection not responding to appropriate antibiotics, and there is likelihood of prolonged periods of granulocytopenia.
Fungal infections are increasingly recognized as pathogens, particularly in patients treated for substantial periods with broad-spectrum anti-bacterial antibiotics. Prompt therapy with Amphotericin-B has been shown to be efficacious even during continuing graulocytopenia.
Cancer patients are liable to develop a deficiency of immune response so that they are more susceptible to infections than patients suffering from other diseases. This aspect has to be kept in mind and wherever necessary and possible, this deficiency is repaired Control of cancer, by itself restores the immune deficiency.
Infection prevention is a critical issue and a major responsibility of those who care for cancer patients. Bolstering of host defense mechanisms, avoidance of unnecessary invasive or traumatic procedures, suppression of organisms colonizing at or near common sites of infection, and reduction of acquisition of hospital-associated organisms, contribute to reduction of the incidence of infection.