The Medical Media Review

Hematologic Emergencies

White cell disorders

  • Tumor lysis syndrome →  allopurinol, hemodialysis
  • Leukostasis (leukemia patient with very high white cell count and neurological changes) → leukophoresis
  • Acute hyperviscosity syndrome (in Waldenström macroglobulinemia) → plasmapheresis

Red blood cell disorders

  • Methemoglobinemia → oxygen, methylene blue
  • Sickle cell emergencies:
    • Acute calculous cholecystitis → antibiotics, consider surgical intervention
    • Acute splenic sequestration crisis (shock, LUQ pain, acute anemia, reticulocytosis) → volume resuscitation, blood transfusion, analgesia
    • Aplastic crisis (low hematocrit and reticulocytopenia  in patient with sickle cell disease, often associated with parvovirus B19, but consider folate deficiency as well)
    • Hemolytic crisis (low hematocrit and reticulocytosis in patient with sickle cell disease)
    • Secondary osteomyelitis: commonly Salmonella species
    • Stroke or TIA → simple or exchange transfusion
    • Vasoocclusive crisis (numerous presentations including acute chest syndrome, neurological events, bone pain, renal papillary necrosis, priapism) → hydration analgesia
  • Polycythemia vera → phlebotomy (venesection)
  • Thrombotic Thrombocytopenic Purpura/Hemolytic Uremic Syndrome (TTP/HUS) → plasma exchange; if unavailable, infuse fresh frozen plasma
  • HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) → delivery
  • Autoimmune hemolytic anemia, warm →  glucocorticoids
  • Carbon monoxide poisoning → oxygen

Platelet disorders

  • Immune thrombocytopenic purpura (mucocutaneous bleeding, thrombocytopenia, no known cause) → treatment options include watchful waiting, glucocorticoids, IVIG, splenectomy
  • Heparin-induced thrombocytopenia → discontinue heparins; consider alternative means of anticoagulation

Coagulopathies

  • Supratherapeutic INR
  • Liver disease
  • Vitamin K deficiency
  • Disseminated intravascular coagulation in acute promyelocytic leukemia (an AML subtype) → all-trans-retinoic acid; FFP, platelets and cryoprecipitate as needed

Transfusion reactions

  • Acute hemolytic
  • Delayed hemolytic
  • Febrile nonhemolytic
  • Allergic
  • Transfusion-related acute lung injury (TRALI)

References

  • Essential Haematology (2011)
  • Pocket Medicine (2010)
  • The Washington Manual of Medical Therapeutics (2010)
  • Master the Boards: USMLE Step 3 (2012)

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Mark Yoffe, MD

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Comments

2 responses to “Hematologic Emergencies”

  1. Sonya D Avatar
    Sonya D

    What about the clotting disorders, like PE or arterial thrombus? Do they count as hematologic emergencies?

    Reply
    1. Mark Yoffe MD Avatar
      Mark Yoffe MD

      Thank you for your comment, Dr. Sonya!

      Those certainly are hematologic emergencies. I left those out of the original post because I anticipated that most doctors would be “too” familiar with those types of emergencies, and I wanted to focus mainly on the rarer ones.

      However, I also want medical students to benefit from these posts as well. As such, your comment makes the list more complete.

      Thank you!

      Reply

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