2025 Multiprofessional Critical Care Review: Adult Online-Hematologic-Oncologic Emergencies

Video Transcription

Video Summary

This talk reviews key hematologic emergencies common in cancer patients, focusing on diagnosis and treatment updates. Tumor lysis syndrome (TLS) involves electrolyte imbalances, with IV hydration and rasburicase preferred over allopurinol for high-risk patients; G6PD screening is necessary before rasburicase use. Malignant hypercalcemia often requires isotonic saline and calcitonin initially, with bisphosphonates like zoledronic acid as definitive therapy, and denosumab for refractory cases or renal failure. Spinal cord compression is managed with steroids and decompression; superior vena cava syndrome may need stenting and radiation. Cardiac tamponade needs urgent pericardiocentesis. Hyperleukostasis calls for leukapheresis and hydroxyurea. Hyperviscosity is treated with plasmapheresis. Immune checkpoint inhibitors cause immune-related adverse events treated primarily with corticosteroids and sometimes infliximab. CAR T-cell therapy toxicities include cytokine release syndrome and neurotoxicity, managed with tocilizumab, corticosteroids, and anakinra. Early identification and tailored treatments of these emergencies improve patient outcomes.

Keywords

hematologic emergencies

tumor lysis syndrome

malignant hypercalcemia

spinal cord compression

immune checkpoint inhibitors

CAR T-cell therapy toxicities

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