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
Excessive bleeding (petechiae, bleeding from venipuncture sites, epistaxis). Predominates in acute DIC
Excessive thrombosis (end-organ dysfunction, thrombophlebitis, PE). Predominates in chronic DIC
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.
Varies based on the site of vaso-occlusion (chest, back, arms, legs, abdomen).
Acute chest syndrome may present with hypoxia, chest pain, fever.
CXR may show pulmonary infiltrate
Analgesia (opiates preferred), hydration, oxygen
Evaluate and treat infections
Admission is needed for patients with acute chest syndrome, infection, aplastic crisis, or refractory pain. ICU is required if hemodynamically unstable.
Discharge is appropriate for patients with a simple pain crisis that has been resolved in the ED. These patients should follow up with their PCP/hematologist.
Many patients will have a individualized prescription/monitoring protocol for vaso-occlusive crises written by their primary sickle cell disease provider. Be sure to use these when available.
It is important to not be distracted by the patient’s history of sicke cell disease. Vaso-occlusive crisis should be a diagnosis of exclusion have ruling out other dangerous etiologies (osteomyelitis, septic joint, organ sequestration, intra-abdominal infection, etc.)
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 are vague and non-specific, generally related to electrolyte abnormalities (nausea/vomiting, diarrhea, lethargy, hematuria, arrhythmias, cramps)
Lab diagnosis requires at least 2 of the following (hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia)