Haematological Emergencies
OVERVIEW
- almost all haematological malignancies are curable with modern treatments such as chemotherapy, radiotherapy, immunotherapy and bone marrow transplantation
CONDITIONS THAT REQUIRE URGENT CHEMOTHERAPIES
- cerebral leukostasis
- pulmonary leukostasis
- leukaemic infiltration of lung
- CNS involvement
- bulky mediastinal involvement compressing vascular structures
- DIC
- severe haemophagocytic syndrome
- non-Hodgkins lymphoma (causing haemoptysis, SVC syndrome, CNS involvement, spinal cord compression, airway compromise, cardiac involvement, massive abdominal tumours)
- leukaemias (acute lymphoblastic, acute promyelocytic, acute myeloid, acute leukaemic of undetermined lineage)
General Management
- consult haematology early
- assess whether can be plasmapheresed
- try and obtain tissue
- prevent and monitor for tumour lysis syndrome (fluid, bloods, allopurinol, rasburicase, electrolyte management)
- steroids
- support haematological parameters with blood products in DIC (if indicated)
- other agents:
-> vincristine
-> cyclophosphamide
-> methotrexate
-> all-trans-retinoic acid
-> daunorubicin
CONDITIONS THAT REQUIRE URGENT PLASMAPHERESIS
- hyperviscosity syndromes (MM, Waldenstrom macroglobulinemia, leukostasis – ALL or AML, sickle cell crisis)
References and Links
LITFL
- ICU Mind Maps — Haematological Malignancies
- ICU Mind Maps — Organ Toxicity of Chemotherapy
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC