Hematology/Oncology

  • Disseminated Intravascular Coagulopathy
  • Henoch-Schonlein Purpura
  • Sickle Cell Crisis
  • Tumor Lysis Syndrome

Disseminated Intravascular Coagulopathy

  • Background
    • Disseminated intravascular coagulation is a condition involving abnormal, excessive generation of thrombin and fibrin in the circulating blood, stimulating both coagulation and fibrinolysis in the body. 
    • Most commonly caused by obstetric complications, infection, cancer, and shock
  • Signs/Symptoms
    • Excessive bleeding (petechiae, bleeding from venipuncture sites, epistaxis). Predominates in acute DIC
    • Excessive thrombosis (end-organ dysfunction, thrombophlebitis, PE). Predominates in chronic DIC
  • Diagnosis
    • Thrombocytopenia, increased PT/PTT, decreased fibrinogen, increased D-dimer. 
  • Treatment
    • Treat underlying illness/injury
    • Replacement therapy (fresh frozen plasma, cryoprecipitate, platelets). Consider heparin for chronic DIC where thrombosis predominates.
Video Credit: Osmosis

*Deep Dive: Disseminated Intravascular Coagulation (Merck Manual)



Henoch-Schonlein Purpura

  • Background
    • Immunoglobulin A–associated vasculitis (formerly called Henoch-Schönlein purpura) is vasculitis that affects primarily small vessels. It occurs most often in children (2-11 years)
  • Signs/Symptoms
    • “Classic Triad” (palpable purpura, arthralgias, and abdominal pain)
    • Commonly causes glomerulonephritis and GI bleeding
  • Diagnosis
    • Usually clinical diagnosis
    • Biopsy of affected organ may help confirm diagnosis
  • Treatment
    • Mostly supportive. 
    • Arthralgias can be managed with NSAIDs. Prednisone may be useful for abdominal pain and renal disease. Consult nephrology if considering immunosuppressant therapy.
Video Credit: Larry Mellick

*Deep Dive: Henoch Schonlein Purpura (NUEM Blog)



Sickle Cell Crisis

  • Background
    • A sickle cell crisis is an acutely painful condition that occurs suddenly in patients with sickle cell anemia when sickled red blood cells cause vaso-occlusion, leading to organ ischemia, pain crisis, and other complications. Acute chest syndrome is the most common presentation for adults. 
  • Signs/Symptoms
    • Varies based on the site of vaso-occlusion (chest, back, arms, legs, abdomen). 
    • Acute chest syndrome may present with hypoxia, chest pain, fever.
  • Diagnosis
    • Clinical diagnosis
    • CXR may show pulmonary infiltrate
  • Treatment
    • Analgesia (opiates preferred), hydration, oxygen
    • Evaluate and treat infections
Video Credit: Daniel McCollum

*Deep Dive: The Sickle Cell Patient – ED Management of Acute Complications (emDOCs)



Tumor Lysis Syndrome

  • Background
    • Tumor lysis syndrome is an oncological emergency that occurs when tumor cells break down releasing large amounts of cellular contents into the bloodstream.  Most commonly occurs after initiating chemotherapy of large cancers as tumor cells are lysed. 
    • Characterized by hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. 
  • Signs/Symptoms
    • Signs/symptoms are vague and non-specific, generally related to electrolyte abnormalities (nausea/vomiting, diarrhea, lethargy, hematuria, arrhythmias, cramps)
  • Diagnosis
    • Lab diagnosis requires at least 2 of the following (hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia)
    • Clinical diagnosis = lab diagnosis + 1 clinical manifestation (AKI, seizure, arrhythmia, sudden death)
  • Treatment
    • Aggressive hydration. Treat underlying electrolyte abnormalities
    • Consult hematology/oncology
Video Credit: EM in 5

*Deep Dive: Tumor Lysis Syndrome (Core EM)


Brandon Simpson, PA-C
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