Documenting a haematology round
Pre-cycle reviews, count reviews, transfusion and product records, and letters to the GP and referrer.
Before cycle three of R-CHOP
Cycle three of R-CHOP 21, stage III diffuse large B-cell lymphoma.
Neutrophils 2.4 with pegfilgrastim, platelets 188, Hb 109.
No fevers since cycle two. Grade 1 constipation from the vincristine, on macrogol daily.
Hep B core antibody positive, surface antigen negative, stays on entecavir 0.5 daily until at least twelve months after the last rituximab.
Proceed at full dose today. Prednisone 100 days one to five. Interim PET after cycle four is booked.
Treatment
R-CHOP-21, cycle 3. Stage III DLBCL. Pegfilgrastim support.
Counts
Neutrophils 2.4, platelets 188, Hb 109.
Toxicity
- No febrile episodes since C2
- Constipation grade 1 (vincristine), macrogol daily
Hepatitis B
HBcAb positive, HBsAg negative. Continue entecavir 0.5 mg daily until at least 12 months after final rituximab.
Plan
- Proceed, full dose
- Prednisone 100 mg days 1 to 5
- Interim PET after C4 (booked)
Correspondence between cycles
- Letter to the GP
- Cycle given, counts, the entecavir and why it must not be stopped, and the febrile neutropenia instruction.
- PET result letter
- The interim response and what it changes, to the GP and the referring physician.
- Transfusion and product notes
- Products given with the threshold that triggered them, in the progress note for that day.
