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