Hematologic and Oncologic Emergencies
Özet
Hematologic and oncologic emergencies are life-threatening acute complications arising from underlying malignancies or their treatments, requiring prompt recognition and medical intervention. This comprehensive review details various critical conditions, including hypercalcemia, which is primarily driven by tumor-secreted parathyroid hormone-related peptide (PTHrP) or osteolytic bone destruction, and is managed via aggressive intravenous hydration, furosemide, bisphosphonates, calcitonin, or denosumab. Tumor lysis syndrome (TLS), categorized by the Cairo-Bishop classification, involves massive intracellular element release leading to hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia; management focuses on risk prevention, hydration, and uric acid-lowering agents like allopurinol or rasburicase. Thrombotic thrombocytopenic purpura (TTP), characterized by an ADAMTS-13 deficiency, mandates therapeutic plasma exchange. Febrile neutropenia, a common chemotherapy complication, requires prompt risk stratification using the MASCC scoring system and empirical antibacterial or antifungal therapies. Additional discussed emergencies include acute blood transfusion reactions ranging from hemolytic to allergic types, sickle cell disease crises (painful crises, acute chest syndrome, priapism, aplastic crises), hyperviscosity syndrome, superior vena cava syndrome (SVCS) causing airway obstruction, and spinal cord compression (SCC) requiring urgent corticosteroids or radiotherapy to safeguard neurological functions.
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