SHM Converge Scientific Abstract ePoster Gallery-In Moments of Crisis, Who Decides What Compassionate Care Really Is?

Pdf Summary

This case describes a 75-year-old woman with newly diagnosed lymphoplasmacytic lymphoma/Waldenström macroglobulinemia, a rare and usually slow-moving non-Hodgkin lymphoma, who presented with rapid clinical decline. She arrived with abdominal pain, confusion, back pain, and difficulty walking, and was found to have fever, severe hypercalcemia, elevated lactate, splenomegaly, and multiple lytic bone lesions on CT. Brain MRI showed calvarial lesions, blood smear showed rouleaux and abnormal red cells, and labs revealed elevated IgM and beta-2 microglobulin. Bone marrow biopsy confirmed the diagnosis.<br /><br />Her hospital course required urgent management of several serious complications at once, including hypercalcemia, pancytopenia, tumor lysis syndrome, acute kidney injury, and volume overload. Treatments included IV fluids, calcitonin, bisphosphonates, transfusions, rituximab and cyclophosphamide, high-dose diuretics, and a time-limited trial of hemodialysis.<br /><br />The case emphasizes that when a patient’s condition changes quickly, goals-of-care discussions must be ongoing and transparent. The care team worked to balance active treatment with the patient’s preferences, especially her wish to remain independent and avoid long-term dialysis, intubation, or resuscitation. Despite initial aggressive interventions, her clinical status worsened, and the team ultimately transitioned her to comfort-focused care.<br /><br />The central lesson is that compassionate care in serious illness requires constant communication, proactive planning, and attention to both medical realities and the patient’s values.

Asset Subtitle

Cole Bourgeois

Meta Tag

Author List Bruno Álvarez Concejo, Cole Bourgeois, Yazan Hijazein

Category Clinical Vignettes

Concept Lymphoplasmacytic Lymphoma

Concept Waldenström Macroglobulinemia

Concept Hyperviscosity Syndrome

Concept Monoclonal IgM Protein

Concept Pancytopenia

Distinguished Non-Finalist

Presenter Organization LSU Health Shreveport

Presenting Author Cole Bourgeois

Track Adult

Keywords

Waldenström macroglobulinemia

lymphoplasmacytic lymphoma

hypercalcemia

tumor lysis syndrome

acute kidney injury

pancytopenia

hemodialysis

bone lesions

goals of care

comfort-focused care

Lymphoplasmacytic Lymphoma

Waldenström Macroglobulinemia

Hyperviscosity Syndrome

Monoclonal IgM Protein

Pancytopenia