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This chapter discusses the diagnosis, evaluation and management of disseminated intravascular coagulation and thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS). The classic presentation of TTP involves a pentad of symptoms that include fever, neurological signs, anemia, thrombocytopenia, and renal dysfunction. This collection of symptoms is only seen in 20-30% of cases and it is strongly recommended to suspect the condition and manage it as such if a patient exhibits three or more of those features. HUS is most commonly seen in children and often follows an infectious illness, usually diarrhea. Morbidity and mortality in patients with TTP/HUS are usually attributed to thrombosis rather than anemia and bleeding. Patients with TTP can present with neurological symptoms that can be life threatening themselves or complicated by a life-threatening event. Patients (usually children) presenting with HUS may have significant renal dysfunction requiring dialysis.
This chapter discusses the management of hematology-oncology emergencies including anticoagulation. Patients on anticoagulation who fall may have no immediate sequelae of an intracranial hemorrhage (ICH). Symptoms can develop over days or even weeks. The most common presentation of intracranial hemorrhage is an insidious onset of headache, light-headedness, nausea, and vomiting. Emergency physicians must maintain a high level of suspicion for intracranial bleeding in patients on anticoagulation, even in the absence of trauma, and particularly in those patients with a supratherapeutic INR. In anticoagulated patients with altered mental status or possible head trauma, a non-contrast computed tomography (CT) is key in identifying intracranial hemorrhage. Anticoagulated patients with head trauma, no loss of consciousness, and a negative initial head imaging should be observed for at least 6 hours (the exact number of hours is controversial) from the onset of the trauma.