Common ED test results that may suggest irAE - interpret along with clinical presentation and other supporting evidence.
Immune-oncology terms with “*” such as CRS and HLH explained further in glossary definitions document.
CBC abnormalities (rare, unlike in chemotherapy)
CRP, ferritin, lactate elevated, fibrinogen low
Metabolic acidosis (low HCO3)
Hyperglycemia +/- anion gap acidosis
AKI (acute kidney injury)
LFT (liver function test)
Elevated CPK, Troponin, BNP
Hypoxemia on Pulse Ox or ABG
EKG with conduction block, tachy- or brady-dysrhythmias, ST changes, electric alternans
Chest x-ray/CT chest infiltrates
Clinical Syndromes: Presentations that may prompt additional testing considerations and interpretations.
The diagnostic workup should be broad, with consideration of other life-threatening illnesses based on the judgment of the treating physician. The information presented is not intended to suggest a standard of care. Once IRAE is identified – contact consulting oncologist or primary oncologist. Immune-oncology terms with “*” such as CRS and HLH explained further in glossary definitions document.
Undifferentiated shock/hypotension- consider:
Sepsis like syndrome (fever, tachycardia, +/- hypotension)- consider:
Short of breath/hypoxia – consider
Short of breath without hypoxia– consider:
Altered mental status- standard workup, including ammonia and head CT, then consider:
Headache (with normal mental status)– CT scan, LP to rule out other causes as indicated. If severe or associated with hypotension, fatigue, meningismus, consider:
Neurological motor weakness/muscle pain – determine CNS vs cranial nerve vs spine vs peripheral etiology; workup as usual and consider
Fatigue - consider
Abdominal pain – usual workup, consider
Diarrhea - usual workup plus
Abnormal bleeding if abnormal CBC, coagulation profile, consider