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Haematology Emergencies

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Haematological Emergency	Clinical Presentation	Diagnostic Tests	Treatment
Disseminated Intravascular Coagulation (DIC)	Diffuse bleeding from multiple sites (e.g., gums, venipuncture sites, GI tract). Petechiae, ecchymoses, and signs of thrombosis (e.g., gangrene, organ dysfunction). Often associated with sepsis, trauma, malignancy, or obstetric complications.	Prolonged PT, aPTT, and elevated D-dimer. Thrombocytopenia and decreased fibrinogen levels. Peripheral blood smear may show schistocytes (fragmented RBCs).	Treat the underlying cause (e.g., antibiotics for sepsis, delivery for obstetric causes). Supportive care with blood products (e.g., platelets, fresh frozen plasma, cryoprecipitate). Heparin may be used in cases with predominant thrombosis. Monitoring of coagulation parameters and organ function.
Thrombotic Thrombocytopenic Purpura (TTP)	Pentad: Fever, neurological symptoms, renal impairment, microangiopathic hemolytic anaemia, and thrombocytopenia. Signs of anaemia (fatigue, pallor) and bleeding (petechiae, bruising). Possible confusion, seizures, or stroke-like symptoms.	Severe thrombocytopenia and microangiopathic hemolytic anaemia (schistocytes on smear). Elevated LDH and indirect bilirubin, decreased haptoglobin. Normal PT and aPTT (unlike DIC).	Plasma exchange (plasmapheresis) is the treatment of choice. Corticosteroids and rituximab may be used as adjunctive therapy. Avoid platelet transfusions unless there is life-threatening bleeding. Monitor for complications such as renal failure and neurological deficits.
Heparin-Induced Thrombocytopenia (HIT)	Thrombocytopenia occurring 5-10 days after heparin exposure. Thrombosis in arteries or veins, leading to complications such as DVT, PE, or stroke. Possible skin necrosis at injection sites.	Platelet count typically drops by more than 50% from baseline. Positive HIT antibody (ELISA) and serotonin release assay (SRA). Doppler ultrasound if DVT is suspected.	Immediate discontinuation of all heparin products. Initiate alternative anticoagulation with a direct thrombin inhibitor (e.g., argatroban, bivalirudin). Avoid warfarin until platelet count has recovered, and overlap with non-heparin anticoagulant when starting. Monitor for thrombotic events and complications.
Acute Hemolytic Transfusion Reaction	Fever, chills, and hypotension shortly after transfusion. Flank pain, hemoglobinuria, and signs of renal failure. Symptoms of shock, including tachycardia and dyspnoea.	Direct Coombs test (positive for IgG or C3 on red cells). Serum free hemoglobin and LDH elevated, haptoglobin decreased. Urinalysis showing hemoglobinuria.	Immediate cessation of the transfusion. Supportive care with IV fluids to maintain renal perfusion. Diuretics (e.g., furosemide) to promote urine output and prevent renal failure. Monitor for DIC and organ dysfunction.
Acute Leukaemia with Tumour Lysis Syndrome	Fever, fatigue, pallor, and bleeding or bruising. Bone pain, hepatosplenomegaly, and lymphadenopathy. Signs of tumour lysis syndrome: hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia.	Complete blood count showing leukocytosis or pancytopenia. Peripheral blood smear may show blasts. Electrolytes, renal function tests, and uric acid levels to assess for tumour lysis syndrome.	IV hydration and allopurinol or rasburicase to prevent or treat tumour lysis syndrome. Initiation of chemotherapy under close monitoring. Correction of electrolyte imbalances and management of renal failure if present. Close monitoring in an ICU setting for severe cases.
Severe Thrombocytopenia	Spontaneous bleeding (e.g., gums, nose, GI tract), petechiae, and bruising. Platelet count <10,000-20,000/µL is particularly concerning. Possible intracranial haemorrhage in very severe cases.	Complete blood count showing severe thrombocytopenia. Peripheral blood smear to rule out platelet clumping or pseudothrombocytopenia. Bone marrow biopsy if the etiology is unclear or if there is suspicion of bone marrow failure.	Platelet transfusions for active bleeding or very low platelet counts. Treatment of the underlying cause (e.g., immunosuppression for ITP, cessation of offending drugs). Avoidance of anticoagulants and antiplatelet agents. Monitoring for signs of bleeding, especially in critical areas such as the brain.
Massive Pulmonary Embolism with Hemodynamic Instability	Sudden onset of shortness of breath, pleuritic chest pain, and syncope. Tachycardia, hypotension, and signs of shock. Signs of right heart strain (e.g., jugular venous distension, right ventricular heave).	CT pulmonary angiography showing large filling defects in the pulmonary arteries. ECG may show right heart strain (e.g., S1Q3T3 pattern, right bundle branch block). ABG may show hypoxemia and respiratory alkalosis.	Immediate anticoagulation with IV heparin. Consider thrombolytic therapy (e.g., alteplase) if hemodynamic instability is present. IV fluids and vasopressors to support blood pressure. Embolectomy may be required if thrombolysis is contraindicated or ineffective.
Acute Sickle Cell Crisis	Severe pain, typically in the bones, chest, or abdomen. Possible fever, swelling, and signs of anaemia (e.g., pallor, fatigue). Complications such as acute chest syndrome (cough, hypoxia), stroke, or splenic sequestration.	Complete blood count showing anaemia and possibly increased reticulocytes. Peripheral blood smear showing sickle-shaped cells. Chest X-ray if acute chest syndrome is suspected.	IV fluids and pain management with opioids. Oxygen therapy for hypoxia. Antibiotics if infection is suspected (e.g., for fever or acute chest syndrome). Blood transfusion may be needed for severe anaemia or acute chest syndrome.
Hyperviscosity Syndrome	Visual disturbances, headache, dizziness, and altered mental status. Possible bleeding, especially mucosal or retinal haemorrhages. Commonly associated with multiple myeloma, Waldenström's macroglobulinemia, or polycythemia vera.	Serum viscosity measurement (elevated levels). Complete blood count showing increased hematocrit or abnormal proteins. Serum protein electrophoresis if monoclonal gammopathy is suspected.	Plasmapheresis to remove excess proteins or red cells. IV fluids to reduce blood viscosity. Treat the underlying cause (e.g., chemotherapy for multiple myeloma). Monitoring for thrombotic or hemorrhagic complications.

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