Download Chapter 24: Hematologic Emergencies

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• Most EMS systems rarely respond to hematologic emergencies.
• Blood performs respiratory, nutritional, excretory, regulatory, and defensive functions.
• Blood is made up of plasma and formed elements, or cells, including red blood cells, white
blood cells, and platelets.
• Laboratory tests commonly performed on blood are red blood cell count, hemoglobin level,
and hematocrit measurement.
• Blood tests that measure subtypes of white blood cells can provide valuable information
about the status of the immune system.
• The ABO system is commonly used to classify blood types.
• During the primary assessment of a patient with a hematologic disorder, note any signs and
symptoms that may be immediately life threatening.
• While taking a history and during the secondary assessment, look for changes in the level of
consciousness such as vertigo, feelings of fatigue, or syncopal episodes.
• General management for any patient with problems related to a blood disorder should
include the following elements: oxygen, fluids, ECG, transport, medications, and
psychological support.
• Hematologic disorders include sickle cell crisis, anemia, leukopenia, thrombocytopenia,
leukemia, lymphomas, polycythemia, DIC, hemophilia, multiple myeloma, and
complications of blood transfusions.
• A patient experiencing a sickle cell crisis will experience significant pain due to congested
vessels and may have a serious infection that can lead to sepsis and death.
• A patient with anemia has a hemoglobin or red blood cell level that is lower than normal.
Anemia may be caused by an underlying hematologic or hemolytic disorder.
• Leukopenia is a reduction in the number of white blood cells and thrombocytopenia, a
reduction in the number of platelets; both are conditions often seen in patients with anemia
or leukemia.
• Leukemia is a type of cancer that affects the production of white blood cells. Patients often
experience bleeding, bruising, infections, and fever.
• Lymphomas are a group of malignant disorders that arise within the lymphoid system. The
two types are non-Hodgkin (making up the majority of cases) and Hodgkin lymphoma.
• Polycythemia is characterized by an overabundance or overproduction of red blood cells,
causing hyperviscosity of the circulatory system.
• Disseminated intravascular coagulation (DIC) may result from a massive injury, sepsis, or
obstetric complications. In the first stage, too much blood clotting results from an
overactivated coagulation system. In the second stage, the body’s natural reaction to
breaking up these clots causes uncontrolled hemorrhage.
• Hemophilia is a bleeding disorder found primarily in the male population in which clotting
does not occur or occurs insufficiently. Type A is due to a low level of factor VIII, and type
B is due to a deficiency in factor IX.
• Multiple myeloma is a cancer of the bone marrow caused by malignant plasma cells.
• Complications of blood transfusions are similar to anaphylactic reactions and are caused by
a mismatch of the patient’s blood type to that received or an allergic reaction to
preservatives or agents in the transfused product.