C09990858 / invoice 10000

Reason: CBC, Cyclophosphamide Diagnosis: Lymphoma stage 5b Other relevant history/comorbidities: Hyphaema prior to starting prednisolone (ddx bleed due to thrombocytopenia vs intraocular lymphoma), thrombocytopenia, anaemia, neutrophilia, preTx with prednisolone, hepatopathy (pre and post pred, resolved midway CHOP)Chemo protocol: CHOP Treatment number: 10/16 History since last visit: -     Appetite normal -     Thirst normal -     Urination normal -     Defecation normal-     Vomiting none -     Other clinical signs none -     Medications given psyllium husk Physical examination: Weight: 26.4kg BSA 0.895m2 BCS: 6/9 T: 38.4 P: 160 -> 72 at reassessment once settled bpm RR:Pant Pant MM colour: Pink, moist CRT: <2s Eyes: Normal Ears: Normal Nose: Normal Oral: Normal Lymph nodes: Static,SMs ~7-8mm slightly bilobed, PSs ~1.5cm soft, POPs 1cm firm. AX and ING not palpable Integument: Normal Respiratory: Normal Cardiac: Focal left apical grade II heart murmur Abdominal palpation: Normal Rectal examination: Not performed Urogenital/mammary: Normal MSK: Normal Neurological: Normal Laboratory: Haematology: Red cell count x 1012/L 5.0 5.5 – 8.5 LHaemoglobin g/L 122 120 – 180 N Haematocrit L/L 0.33 0.37 – 0.55 LReticulocytes x 109/L 225 10 – 110 HNRBC% % 3.6 < 1.5 HNeutrophils x 109/L 4.2 3.0 – 11.5 NPlatelets x 109/L 760 200 – 500 HAssessment: Tumour response: CRToxicity from previous chemo:  Grade 1 anaemia (regenerative this week)Treatment: Cyclophosphamide 234mg/m2 = 210mg, ~8% dose escalationMedications at home: Maropitant 60mg SID PRN for nausea Psyllium husk 2tsp BID PRN for diarrhoea Ondansetron 8mg BID PRN ofr nausea Loperamide 2mg TID PRN for diarrhoea Plan: Recheck in 7 days for exam, CBC and vincristine (#11/16)    Vital Signs    MMColour: Pink;       Weight: 26.4;       Temperature: 38.4;       HeartRate: 160;       RespirationRate: Pant;       CRT: <2;