A hematological emergency is an acute, life-threatening complication of a blood disease or of its treatment, in which recognition and treatment in the first hours decide the outcome. The emergencies differ in mechanism. A tumor can compress the spinal cord from outside. A leukemia can drive the clotting system into clotting and bleeding at the same time (a coagulopathy, meaning a disorder of blood clotting), and the treatment of that leukemia can itself cause a second emergency. Cancer treatment can also remove the neutrophils, the white blood cells that hold bacterial infection back.
- Neoplastic Epidural Spinal Cord Compression (ESCC) explains the anatomy of the cord and its coverings, the epidural space that makes the compression possible, the tumors that cause it, its symptoms and radiological work-up, its differential diagnosis, and the use of high-dose dexamethasone.
- Emergent Complications of Acute Promyelocytic Leukemia (APML) explains the 15;17 translocation and the PML-RARA block, the coagulopathy that kills before treatment begins, and the ATRA treatment that reverses it.
- Differentiation Syndrome in Acute Promyelocytic Leukemia explains the complication that follows the successful treatment of APML, its features, its mimics and its management with corticosteroids.
- Neutropenic Fever explains the definition and thresholds, the reason chemotherapy can cause an abrupt neutropenia, the organisms that matter, and the considerations behind empiric antimicrobial treatment.
Start with the note on spinal cord compression: it begins with the anatomy of the cord and its coverings. The APML and differentiation syndrome notes follow one disease from its bleeding emergency to the complication of its treatment, so they are best read in that order; the neutropenic fever note deals with a different mechanism and can be read on its own.