Hematologic emergencies

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The hyperleukocytic syndrome commonly affects circulation in the lungs and central nervous system of patients with acute leukemia; the death rate is high if intracranial hemorrhage occurs. Disseminated intravascular coagulopathy is almost always a manifestation of some other disorder, which should be the primary target of therapy. In patients with thrombotic thrombocytopenic purpura, platelet aggregation affects the microcirculation of the brain, heart, kidneys, and adrenal glands. In this article, the authors discuss management of all three conditions. A companion article on page 183 focuses on transfusion reactions and crises in sickle cell disease.