HEMATOLOGIC EMERGENCIES

Benign Heme Emergencies Malignant Heme Emergencies

Autoimmune hemolytic anemia Hypercalcemia
TTP Hyperleukocytosis
Sickle cell crisis Hyperviscosity
Acute tumor lysis syndrome
Acute cord compression
Superior vena cavae syndrome

Acute cord compression

• Lung ca > Breast ca > Prostate ca
• Thoracic spine > Cervical spine > Lumbar spine
• 90% pain; 75% weakness; 50% loss of bladder/bowel function
• Treatment: XRT + IV Dex + surgery (if able) best outcomes

Tumor lysis syndrome

• More common: high-grade lymphoma (Burkits) or acute leukemia (ALL)
• Tumor lysis Labs: ↑ uric acid, ↑ K, ↑ Phos, ↓ Ca
• Clinical tumor lysis = Tumor lysis labs + one of the following:
o Cr > 1.5, Arrythmia, Seizure, or Death
• Prophylaxis and Treatment:
o IVF
o Allopurinol
o Rasbirucase

Hypercalcemia
• Etiologies
o PTH-rP (80%): Sq cell CA (lung, Head & Neck), RCC, Bladder, Breast, Ovarian
o Osteolysis from bone mets (20%): Multiple myeloma, Breast, Lung
o Excess Vit D production from malignant cells: least common
• Sx: lethargy, confusion, nausea, constipation, polyuria, polydipsia, arrhythmias (bradycardia, short QT, cardiac arrest)
• Treatment (for Ca > 12-14):
o IVF
o Calcitonin
o Pamidronate
o Zolendronic acid
o Steroids
o Furosemide (only use on euvolemic patients)

Superior vena cavae syndrome

• Etiologies
o Non-malignancy: thrombosis, fibrosing mediastinitis, post-radiation fibrosis
o Malignancy: lung ca, lymphoma (diffuse large B-cell)
• Initial treatment: Airway management
• Definitive treatment: XRT, chemo, endovascular stenting

HEMATOLOGIC URGENCIES
Neutropenic fever
Transfusion reaction
DIC
AML w/o hyperleukocytosis
Bleeding diathesis