Some haematological conditions may present as emergencies in primary care. These require urgent intervention and clinical vigilance in order to diagnose and manage patients appropriately, as patients will often present with non-specific symptoms and signs. This article will discuss four major haematological presentations. We will consider the aetiology of each condition, how patients present in primary care, how to manage these presentations, and what patients are likely to experience when seen in secondary care.
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References
1.
AbelGAMendoncaSCMcPhailS, et al. (2017) Emergency diagnosis of cancer and previous general practice consultations: Insights from linked patient survey data. British Journal of General Practice67(659): e377–e387. DOI: 10.3399/bjgp17X690869.
2.
ArnoldDMNaziIWarkentinTE, et al. (2013) Approach to the diagnosis and management of drug-induced immune thrombocytopenia. Transfusion Medicine Reviews27(3): 137–145. DOI: 10.1016/j.tmrv.2013.05.005.
3.
AtkinCIqbalGPlancheT, et al. (2020) Diagnostic pathways in multiple myeloma and their relationship to end organ damage: An analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) trial. British Journal of Haematology192(6): 997–1005. DOI: 10.1111/bjh.17044.
4.
BowenDT (2006) Etiology of acute myeloid leukemia in the elderly. Seminars in Hematology43(2): 82–88. DOI: 10.1053/j.seminhematol.2006.01.005.
ChisholmJCDommettR (2006) The evolution towards ambulatory and day-case management of febrile neutropenia. British Journal of Haematology135(1): 3–16. DOI: 10.1111/j.1365-2141.2006.06253.x.
7.
DimopoulosMRoussouMGavriatopoulouM, et al. (2017) Outcomes of newly diagnosed myeloma patients requiring dialysis: Renal recovery, importance of rapid response and survival benefit. Blood Cancer Journal7(6): e571DOI: 10.1038/bcj.2017.49.
8.
FernandezHFSunZYaoX, et al. (2009) Anthracycline dose intensification in acute myeloid leukemia. New England Journal of Medicine361(13): 1249–1259. DOI: 10.1056/NEJMoa0904544.
9.
FordAMarshallE (2014) Neutropenic sepsis: A potentially life-threatening complication of chemotherapy. Clinical Medicine14(5): 538–542. DOI: 10.7861/clinmedicine.14-5-538.
10.
Häggström M (2014) Medical gallery of Mikael Häggström 2014. WikiJournal of Medicine 1(2): 30–35. DOI: 10.15347/wjm/2014.008.
11.
HayashiH (2014) Management of thrombocytopenia due to liver cirrhosis: A review. World Journal of Gastroenterology20(10): 2595–2605DOI: 10.3748/wjg.v20.i10.2595.
KastritisEKatodritouEPouliA, et al. (2011) Frequency and prognostic significance of hypercalcemia in patients with multiple myeloma: An analysis of the database of the Greek Myeloma Study Group. Blood118(21): 409–414. DOI: 10.1111/ejh.12923.
14.
KochanekMSchalkEBergwelt-BaildonMV, et al. (2019) Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Annals of Hematology98(5): 1051–1069. DOI: 10.1007/s00277-019-03622-0.
15.
KumarVAbdulazeezMFBiswasS, et al. (2019) Trends in early mortality from multiple myeloma (MM): A population-based analysis. Blood134(Supplement_1): 76–80. DOI: 10.1016/S2152-2650(20)30470-5.
16.
LeoneGPaganoLBen-YehudaD, et al. (2007) Therapy-related leukemia and myelodysplasia: Susceptibility and incidence. Haematologica. Pavia, Italy92(10): 1389–1398. DOI: 10.3324/haematol.11034.
17.
LyratzopoulosGSaundersCLAbelGA, et al. (2015) The relative length of the patient and the primary care interval in patients with 28 common and rarer cancers. British Journal of Cancer112(S1): S35–40. DOI: 10.1038/bjc.2015.40.
18.
McGregor C (2014) Improving time to antibiotics and implementing the “Sepsis 6”. BMJ Quality Improvement Reports 2(2): u202548.w1443. DOI: 10.1136/bmjquality.u202548.w1443.
19.
National Cancer Intelligence Network and Public Health England (2014) National Cancer Intelligence Network trends in incidence and outcome for haematological cancers in England 2001-2010. Available at: www.ncin.org.uk/view?rid=2818 (accessed 13 October 2020).
NICE (2008) Metastatic spinal cord compression in adults: Risk assessment, diagnosis and management. Available at: www.nice.org.uk/guidance/cg75 (accessed 16 November 2020).
22.
NICE (2012) Neutropenic sepsis: Prevention and management in people with cancer. Available at: www.nice.org.uk/guidance/cg151 (accessed 16 November 2020).
SlichterS (2004) Relationship between platelet count and bleeding risk in thrombocytopenic patients. Transfusion Medicine Reviews18(3): 153–167. DOI: 10.1016/j.tmrv.2004.03.003.
StasiR (2012) How to approach thrombocytopenia. Hematology2012(1): 191–197. DOI: 10.1182/asheducation-2012.1.191.
29.
WitkowskiMWitkowskaMRobakT (2019) Autoimmune thrombocytopenia: Current treatment options in adults with a focus on novel drugs. European Journal of Haematology103(6): 531–541. DOI: 10.1111/ejh.13319.
30.
YadavPCookMCockwellP (2016) Current trends of renal impairment in multiple myeloma. Kidney Diseases1(4): 241–257. DOI: 10.1159/000442511.