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