EM Boards Survival Guide: Hematology/Oncology 1

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit)

This week’s Survival Guide brings you a difficult topic: hematology/oncology. Read on for key resources and commonly tested concepts.


Boards Must-Knows:

1) Blood products: Transfusion reactions most high-yield; sometimes individual components are tested as well. Know presentations / management of: febrile // hemolytic – acute & delayed // TRALI. Know Hgb transfusion threshold and type of blood to give. Know when to transfuse platelets. Know PCC vs FFP. Know who may benefit from cryoprecipitate.

LIFTL

WikEM

emDocs Transfusion Reaction

FOAMCast Transfusion Reaction

 

2) DIC: Most common etiology is sepsis. Patients bleed and clot. Know lab findings and contrast with vWD / ITP / TTP. Identify and treat trigger.

emDocs

LIFTL

WikEM

 

3) Methemoglobinemia: Know classic meds/scenarios. Blue skin, chocolate blood, and oxygen saturation 85% that does not improve with O2 administration. Treat with methylene blue.

CoreEM

ToxCard

WikEM

 

4) Hemophilia: VIII (A) and IX (B). Know formulas to replace factors for minor and severe bleeding.

REBEL EM

Peds EM Morsels

WikEM

 

5) ITP: Know common presentations => petechiae, epistaxis, easy bleeding with brushing teeth, etc. Coagulation panel normal. Treat PRN with steroid, IVIG. Spontaneous serious bleeds when plts < 10,000. Kids recover well; tends to be a chronic disease in adults.

emDocs

WikEM

 

6) HSP: IgA vasculitis. Arthralgias + palpable purpura + kidney involvement. Love to test abdominal pain = intussusception. Typically do well and can be discharged with follow-up.

EM@3AM

WikEM

Peds EM Morsels

 

7) Hypercalcemia (malignancy): Know classic presentation. Rate of Ca rise determines symptoms. In ED setting, it’s mostly about hydration; other options as inpatient.

WikEM

CoreEM

 

8) Hyperviscosity syndrome: Think sludging in any organ system, but especially pulmonary and neurologic systems. Need leukapheresis or plasmapheresis / chemotherapy.

emDocs

WikEM

 

9) Microcytic anemia: Know differential diagnosis => Fe deficiency, anemia of chronic disease, thalassemia, sideroblastic anemia. Most common cause of anemia in young/middle-aged female: Fe deficiency.

LIFTL

WikEM

 

10) Macrocytic anemia: Know how to differentiate B12 (neuro symptoms) vs folate deficiency.

LIFTL

WikEM, B12 deficiency, folate deficiency

 

One thought on “EM Boards Survival Guide: Hematology/Oncology 1”

Leave a Reply

Your email address will not be published. Required fields are marked *