Hematology Oncology

A

• Acute Chest Syndrome in Sickle Cell Disease — Antibiotics, Bronchodilators, and (Exchange) Transfusion

  New pulmonary infiltrate plus fever and/or respiratory symptoms in sickle cell disease. Provide oxygen, antibiotics (cover atypicals), incentive spirometry, and bronchodilators; transfuse simple or exchange based on severity and Hb; involve hematology early.
• Anticoagulant Reversal — Life Threatening Bleeding

  Identify the agent and last dose; provide targeted reversal and hemostatic support while controlling the bleeding source.

D

• Deep Vein Thrombosis — Diagnosis & Anticoagulation

  Use Wells score to risk stratify; D-dimer to rule out in low-risk; confirm with compression ultrasound; start anticoagulation unless contraindicated; choose DOAC for most; treat 3 months minimum.
• Disseminated Intravascular Coagulation — Diagnosis & Treatment

  DIC is a consumptive coagulopathy from systemic activation of coagulation (sepsis, malignancy, trauma, obstetric). Diagnose with clinical context and labs (↑PT/INR, ↑aPTT, ↓fibrinogen, ↑D‑dimer, thrombocytopenia). Treat cause; provide targeted blood products; consider heparin in chronic DIC.
• Disseminated Intravascular Coagulation — Treat Cause and Support

  Consumptive coagulopathy from sepsis, trauma, or malignancy; treat underlying cause and support with products guided by bleeding and labs; consider heparin for thrombosis-predominant DIC.

F

• Febrile Neutropenia — Risk Scores, Broad‑Spectrum IV Antibiotics, and Antifungal Escalation

  Defined as fever with ANC <500 (or expected). Start broad‑spectrum IV antibiotics within 60 minutes of presentation. Use MASCC/CISNE scores to triage for inpatient vs outpatient therapy; add antifungal coverage if persistent fever after 4–7 days or earlier if instability or imaging suggests fungal disease.
• Febrile Neutropenia — Risk Scores, Early Antipseudomonal Coverage, and Disposition

  Fever with ANC <500 (or expected to decline) after chemotherapy. Obtain cultures quickly and start an antipseudomonal β‑lactam within 60 minutes; add MRSA coverage only with specific indications. Use MASCC/CISNE for risk and consider outpatient oral therapy for low‑risk patients.

H

• Hemolytic Anemia — DAT‑Positive vs DAT‑Negative Evaluation

  Differentiate immune from non‑immune hemolysis using DAT and peripheral smear; treat underlying cause and initiate corticosteroids for warm AIHA; urgent support for severe hemolysis.
• Heparin‑Induced Thrombocytopenia — 4Ts & Anticoagulation

  Suspect HIT with platelet drop 5–10 days after heparin; use 4Ts score; stop all heparin and start non‑heparin anticoagulant while confirming diagnosis.
• Heparin‑Induced Thrombocytopenia — 4Ts Score, PF4 Testing, and Non‑Heparin Anticoagulation

  Immune‑mediated thrombocytopenia with thrombosis risk 5–10 days after heparin exposure. Use 4Ts score for pretest probability, stop all heparin, send PF4 immunoassay with functional testing as needed, and start a non‑heparin anticoagulant while awaiting confirmatory testing.
• Hodgkin Lymphoma — Initial Workup & Staging

  Classical HL: obtain PET‑CT, stage with Ann Arbor, document B symptoms, and plan ABVD‑based therapy with consideration of bulky disease and interim PET adaptation.
• Hypercalcemia of Malignancy — Fluids, Calcitonin, and Anti‑Resorptives

  Cancer‑related hypercalcemia requires isotonic fluids, short‑term calcitonin for rapid reduction, and anti‑resorptives (IV bisphosphonates or denosumab) for sustained control; add dialysis for severe/renal failure. Treat underlying malignancy and limit calcium/vitamin D.
• Hypercalcemia of Malignancy — Fluids, Calcitonin, and Bisphosphonate/Denosumab

  Treat symptomatic or severe hypercalcemia with aggressive IV saline, calcitonin for rapid effect, and IV bisphosphonate (zoledronic acid/pamidronate) or denosumab for sustained control; stop exacerbating drugs and treat the underlying malignancy.

I

• Immune Thrombocytopenia (ITP) — First‑ and Second‑Line Therapy

  Diagnosis of exclusion; treat when platelets <30k or bleeding; first‑line corticosteroids or IVIG; second‑line TPO‑RA, rituximab, or splenectomy.
• Immune TTP — ADAMTS13, Plasma Exchange, Steroids, and Caplacizumab

  Suspect iTTP with MAHA and thrombocytopenia; send ADAMTS13 urgently and begin plasma exchange plus high-dose steroids immediately; add caplacizumab when iTTP is likely to reduce time to platelet recovery and relapses.
• Indolent Non‑Hodgkin Lymphoma — Watchful Waiting vs Treatment

  Many indolent NHLs (e.g., follicular) can be observed initially. Treat when GELF criteria or symptoms present; prefer anti‑CD20‑based regimens; monitor for transformation.
• Iron Deficiency Anemia — Workup & IV Iron

  Diagnose with ferritin and iron studies; identify bleeding sources; treat with oral or IV iron depending on severity/tolerance; replete stores and monitor response.

M

• Malignant Spinal Cord Compression — Emergency Care

  Back pain with neurologic deficits in cancer patients requires urgent MRI, high dose steroids, and oncology and surgical consultation for decompression and radiotherapy.
• Malignant Spinal Cord Compression — Steroids and Oncologic Urgency

  Oncologic emergency: back pain with neurologic deficits; give dexamethasone promptly, obtain urgent MRI, and coordinate radiation or surgery with oncology and neurosurgery.
• Malignant Spinal Cord Compression — Steroids, MRI, and Urgent Decompression/Radiation

  Back pain with neurologic deficits in cancer patients is an emergency. Give dexamethasone promptly, obtain MRI whole spine, and coordinate urgent surgical decompression and/or radiotherapy based on stability, radiosensitivity, and prognosis.
• Myelodysplastic Syndromes — Risk Stratification & Treatment

  Heterogeneous clonal disorders with cytopenias and risk of AML transformation. Diagnose with marrow morphology and cytogenetics/molecular profiling. Use IPSS‑R/IPSS‑M to stratify risk and guide therapy from supportive care to HMA or transplant.

N

• Neutropenic Fever — Initial Management

  Oncologic emergency: start antipseudomonal antibiotics within 60 minutes; risk stratify (MASCC/CISNE); add MRSA coverage only for specific indications; consider antifungal if persistent fever after 4–7 days.

S

• Sickle Cell Acute Chest Syndrome — Antibiotics, Bronchodilators, and Transfusion Strategy

  New pulmonary infiltrate with fever and/or respiratory symptoms in sickle cell disease. Provide oxygen, incentive spirometry, pain control, antibiotics, and transfusion (simple vs exchange) based on severity; avoid fluid overload and treat concomitant VOC.
• Sickle Cell Disease — Acute Crisis & Disease‑Modifying Therapy

  Manage acute pain crises, prevent complications (ACS, stroke), and use disease‑modifying therapy (hydroxyurea, transfusions; selected newer agents). Vaccinate and provide comprehensive care.
• Sickle Cell Vaso Occlusive Crisis — Analgesia and Complications

  Rapid multimodal analgesia with opioids and NSAIDs when not contraindicated, aggressive hydration as needed, and vigilance for acute chest syndrome and infection.
• Superior Vena Cava Syndrome — Oncologic Emergency

  Obstruction of venous return from mediastinal mass or thrombosis causing facial and arm swelling, dyspnea, and venous distention; elevate head, give oxygen, obtain contrast CT, and coordinate urgent stent or tumor directed therapy.

T

• Transfusion Thresholds in Adults — Restrictive Strategy

  Restrictive transfusion is safe for many hospitalized adults; consider transfusion at hemoglobin around 7 g dL in stable noncardiac patients and higher thresholds in specific conditions.
• Tumor Lysis Syndrome — Prevention & Management

  Oncologic emergency from rapid cell lysis causing hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Prevent with risk stratification, vigorous hydration, and urate‑lowering therapy; manage electrolyte derangements promptly; dialyze if refractory.
• Tumor Lysis Syndrome — Prevention & Treatment

  Oncologic emergency with hyperkalemia, hyperphosphatemia, hypocalcemia, and AKI; risk-stratify, hydrate aggressively, give allopurinol or rasburicase as indicated, and manage electrolytes.
• Tumor Lysis Syndrome — Prevention and Treatment

  Identify high risk hematologic malignancies, start aggressive hydration, control uric acid with allopurinol or rasburicase, and manage electrolytes; dialyze when refractory.
• Tumor Lysis Syndrome — Prevention, Rasburicase vs Allopurinol, and Renal Protection

  High‑grade hematologic malignancies carry TLS risk at chemo initiation. Stratify risk; give aggressive hydration, allopurinol for low‑moderate risk, or rasburicase for high‑risk or established hyperuricemia. Monitor electrolytes closely; treat hyperkalemia/hyperphosphatemia; consider early dialysis for AKI.
• Tumor Lysis Syndrome — Risk Stratification, Hydration, and Uric Acid Control

  TLS arises after cytotoxic therapy (or spontaneously) in high-burden hematologic malignancy. Prevent with aggressive isotonic fluids, strict monitoring of potassium, phosphate, calcium, uric acid, and renal function, and early uric acid–lowering therapy (rasburicase for high risk).
• Tumor Lysis Syndrome — Risk Stratification, Rasburicase/Allopurinol, and Renal Support

  Rapid tumor cell breakdown after cytotoxic therapy (or spontaneously) causing hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Risk‑stratify, start aggressive hydration, give allopurinol for prevention or rasburicase for treatment, and monitor electrolytes/renal function closely; initiate dialysis when refractory.