COVID-19 and Cytokine Release Syndrome (CRS also known as Cytokine Storm).
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One of the issues found with the Stay-At-Home aspect of Social distancing is the CRS issue in 20% of the critical cases. Symptoms of CRS are caused by a widespread immune response in the body. Different organ systems can be affected with a range of symptoms. In some cases, CRS can cause life-threatening changes in heart, lung, kidney, liver, and brain function.
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CRS occurs when large numbers of white blood cells are activated and release inflammatory cytokines, which in turn activate yet more white blood cells. CRS is also an adverse effect of some monoclonal antibody drugs, as well as adoptive T-cell therapies.
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Anti-inflammatory and immunosuppressive drugs have not been successful in treating cytokine storm and improving survival. Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, are used commonly to treat mild to moderate inflammation, but have not demonstrated the ability to control cytokine storm.
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The symptom complex is associated with the use of many monoclonal antibodies. Commonly referred to as an infusion reaction, it results from the release of cytokines from cells targeted by the antibody as well as immune effector cells recruited to the area. When cytokines are released into the circulation, systemic symptoms such as fever, nausea, chills, hypotension, tachycardia, asthenia, headache, rash, scratchy throat, and dyspnea can result. In most patients, the symptoms are mild to moderate in severity and are managed easily. However, some patients may experience severe, life-threatening reactions that result from massive release of cytokines. Severe reactions occur more commonly during the first infusion in patients with hematologic malignancies who have not received prior chemotherapy; severe reactions are marked by their rapid onset and the acuity of associated symptoms. Massive cytokine release is an oncologic emergency, and special precautions must be taken to prevent life-threatening complications. This article will present an overview of the etiology and management of cytokine-release syndrome in patients receiving monoclonal antibodies to better prepare oncology nurses to safely care for such patients.
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Summary: CRS needs to be distinguished from symptoms of the disease itself and, in the case of drugs, from other adverse effects.
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1SG John Faircloth - PO1 H Gene Lawrence - PO1 Richard Nyberg - 1SG Steven Imerman - PO3 Lynn Spalding - SGT David A. 'Cowboy' Groth - SSG Donald H "Don" Bates - PO1 William "Chip" Nagel - Lt Col John (Jack) Christensen - Lt Col Charlie Brown - SGT (Join to see) - SSgt Joseph Baptist - MAJ Byron Oyler - SSgt Joseph Baptist - SSgt Terry P. - PO1 Richard Nyberg - 1SG Steven Imerman - SSG Donald H "Don" Bates - Sgt Albert Castro - PO3 Bob McCord -