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