Hematologic Emergencies

  • Shuwei Gao
  • Khanh Vu
  • Francisca Gushiken
  • Khanh Thi Thuy NguyenEmail author
Part of the MD Anderson Cancer Care Series book series (MDCCS)


Hematologic emergencies are acute, life-threatening events. Cancer, its treatments, and its baseline comorbidities can independently or collectively lead to hematologic emergencies requiring quick recognition, prompt diagnosis, and swift delivery of therapeutic interventions by frontline clinicians. The hematologic emergencies frequently encountered in cancer patients described in this chapter include venous thromboembolism (VTE), .hyperviscosity syndrome (HVS), anemia, thrombocytopenia, acute hemorrhage, and transfusion reactions.


Hematologic Venous thromboembolism Hyperviscosity Anemia Hemorrhage Transfusion reaction 

Suggested Readings

  1. Adams BD, Baker R, Lopez JA, Spencer S. Myeloproliferative disorders and the hyperviscosity syndrome. Emerg Med Clin North Am. 2009;27:459–76.CrossRefPubMedGoogle Scholar
  2. Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293:715–22.CrossRefPubMedGoogle Scholar
  3. Bug G, Anargyrou K, Tonn T, et al. Impact of leukapheresis on early death rate in adult acute myeloid leukemia presenting with hyperleukocytosis. Transfusion. 2007;47:1843–50.CrossRefPubMedGoogle Scholar
  4. Carrier M, Lee AY, Bates SM, Anderson DR, Wells PS. Accuracy and usefulness of a clinical prediction rule and d-dimer testing in excluding deep vein thrombosis in cancer patients. Thromb Res. 2008;123:177–83.CrossRefPubMedGoogle Scholar
  5. Carson JL, Kelley MA, Duff A, et al. The clinical course of pulmonary embolism. N Engl J Med. 1992;326:1240–5.CrossRefPubMedGoogle Scholar
  6. Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006;166:458–64.CrossRefPubMedGoogle Scholar
  7. Donze J, Le Gal G, Fine MJ, et al. Prospective validation of the pulmonary embolism severity index. A clinical prognostic model for pulmonary embolism. Thromb Haemost. 2008;100:943–8.PubMedGoogle Scholar
  8. Geraci JM, Hansen RM, Kueck BD. Plasma cell leukemia and hyperviscosity syndrome. South Med J. 1990;83:800–5.CrossRefPubMedGoogle Scholar
  9. Harrison CN, Campbell PJ, Buck G, et al. Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia. N Engl J Med. 2005;353:33–45.CrossRefPubMedGoogle Scholar
  10. Kaminsky DA, Hurwitz CG, Olmstead JI. Pulmonary leukostasis mimicking pulmonary embolism. Leuk Res. 2000;24:175–8.CrossRefPubMedGoogle Scholar
  11. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e419S–94.PubMedCentralPubMedGoogle Scholar
  12. Kennedy LD, Case LD, Hurd DD, Cruz JM, Pomper GJ. A prospective, randomized, double-blind controlled trial of acetaminophen and diphenhydramine pretransfusion medication versus placebo for the prevention of transfusion reactions. Transfusion. 2008;48:2285–91.CrossRefPubMedGoogle Scholar
  13. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144:165–71.CrossRefPubMedGoogle Scholar
  14. Lee AY, Levine MN, Baker RI, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349:146–53.CrossRefPubMedGoogle Scholar
  15. Lester TJ, Johnson JW, Cuttner J. Pulmonary leukostasis as the single worst prognostic factor in patients with acute myelocytic leukemia and hyperleukocytosis. Am J Med. 1985;79:43–8.CrossRefPubMedGoogle Scholar
  16. Lyman GH, Khorana AA, Falanga A, et al. American society of clinical oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol. 2007;25:5490–505.CrossRefPubMedGoogle Scholar
  17. Menell JS, Cesarman GM, Jacovina AT, McLaughlin MA, Lev EA, Hajjar KA. Annexin II and bleeding in acute promyelocytic leukemia. N Engl J Med. 1999;340:994–1004.CrossRefPubMedGoogle Scholar
  18. Meyer T, Binder L, Hruska N, Luthe H, Buchwald AB. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J Am Coll Cardiol. 2000;36:1632–6.CrossRefPubMedGoogle Scholar
  19. Michiels JJ, Berneman Z, Van Bockstaele D, van der Planken M, De Raeve H, Schroyens W. Clinical and laboratory features, pathobiology of platelet-mediated thrombosis and bleeding complications, and the molecular etiology of essential thrombocythemia and polycythemia vera: therapeutic implications. Semin Thromb Hemost. 2006;32:174–207.CrossRefPubMedGoogle Scholar
  20. Pescatore SL, Lindley C. Anagrelide: a novel agent for the treatment of myeloproliferative disorders. Expert Opin Pharmacother. 2000;1:537–46.CrossRefPubMedGoogle Scholar
  21. PIOPED Investigators Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators. JAMA. 1990;263:2753–59.Google Scholar
  22. Porcu P, Danielson CF, Orazi A, Heerema NA, Gabig TG, McCarthy LJ. Therapeutic leukapheresis in hyperleucocytic leukaemias: lack of correlation between degree of cytoreduction and early mortality rate. Br J Haematol. 1997;98:433–6.CrossRefPubMedGoogle Scholar
  23. Refaai MA, Goldstein JN, Milling Jr TJ, et al. Randomized phase IIIb study of rapid vitamin K antagonist reversal in patients requiring an urgent surgical procedure: four-factor prothrombin complex concentrate is superior to plasma. Blood. 2013;122:3588.Google Scholar
  24. Regev A, Stark P, Blickstein D, Lahav M. Thrombotic complications in essential thrombocythemia with relatively low platelet counts. Am J Hematol. 1997;56:168–72.CrossRefPubMedGoogle Scholar
  25. Sampson FC, Goodacre SW, Thomas SM, van Beek EJ. The accuracy of MRI in diagnosis of suspected deep vein thrombosis: systematic review and meta-analysis. Eur Radiol. 2007;17:175–81.CrossRefPubMedGoogle Scholar
  26. Sarode R, Milling Jr TJ, Refaai MA, et al. Efficacy and safety of a four-factor prothrombin complex concentrate (4f-pcc) in patients on vitamin k antagonists presenting with major bleeding: a randomized, plasma-controlled, phase IIIb study. Circulation. 2013;128:1234–43.PubMedGoogle Scholar
  27. Sohne M, Ten Wolde M, Boomsma F, Reitsma JB, Douketis JD, Buller HR. Brain natriuretic peptide in hemodynamically stable acute pulmonary embolism. J Thromb Haemost. 2006;4:552–6.CrossRefPubMedGoogle Scholar
  28. Stein PD, Terrin ML, Hales CA, et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100:598–603.CrossRefPubMedGoogle Scholar
  29. Thomas SM, Goodacre SW, Sampson FC, van Beek EJ. Diagnostic value of CT for deep vein thrombosis: results of a systematic review and meta-analysis. Clin Radiol. 2008;63:299–304.CrossRefPubMedGoogle Scholar
  30. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135:98–107.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Shuwei Gao
    • 1
  • Khanh Vu
    • 1
  • Francisca Gushiken
    • 2
  • Khanh Thi Thuy Nguyen
    • 1
    Email author
  1. 1.Department of General Internal Medicine, Unit 428The University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Internal MedicineSouth Texas Veterans Health Care SystemSan AntonioUSA

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