#  Hematologic Emergencies in the ICU

## Acute Promyelocytic Luekemia

Often leukopenic (due to fragile cells) vs hyperleukocytosis in other AML, present in DIC/ecchymosis/severe coagulopathy. 

Treatment: 

- ATRA, low risk so makes sense to treat if ambiguous and not excluded. 

Side effects:

- Beware of ATRA differentiation syndrome -> capillary leak physiology. Treat with dexamethasone
- ATRA induced leukocytosis -> differentiation leads to high WBC. Add doxorubicin
- Psuedotumor cerebri 


## Leukostasis

- Hyperleukocytosis = over 100k
- Leukostasis = hyperleukocytosis and symptoms (though can be lower than 100k, esp if acute leuk blast crisis = large blasts)

(note: differentiate from hyperviscosity syndrome caused by hyper-proteinemia)

Symptoms: 

- CNS: vision changes, headache, somnolence
- Lungs: dyspnea, hypoxemia

Workup: 

- CNS imaging - risk of bleed
- Hypoxemia: can have falsely low Po2 due to metabolism of O2 in ABG tube. Use SpO2

Treatment: 

- fluids
- avoid diuretics, PRBCs -> increase viscocity
- aggressive platelet support due to increased risk of CNS bleed which continues for several days after reduction
- cytoreduction with treatment and/or leukopheresis

## DIC

## SVC

## Cord Compression

## TLS

Definition:  25% increase from baseline of K, Phos, Uric or 25% decrease of Ca

- IVF
- Allopurinol
- Add rasburicase if AML WBC over 50 or ALL WBC over 100.
- Dialysis

## Cytokine Release Syndrome

Go to the binder and call oncology