Highlighted below are examples of emergencies that should prompt referral to the nearest emergency department and be discussed with the hematologist on call. Note that this is not an exhaustive list
The finding of blasts or fragments/schistocytes in peripheral blood
Platelet count less than 20 x 109/L
Any degree of thrombocytopenia accompanied by laboratory evidence of hemolysis, coagulopathy or acute renal injury
A neutrophil count less than 0.5 x109/L accompanied by fever
A fall in platelet count > 50% from baseline within 5-10 days of new heparin exposure
Suspected tumor lysis syndrome, defined as acute hyperkalemia, hyperphosphatemia, hypocalcemia, and high uric acid levels in a patient with a hematologic malignancy
New onset hemoglobin < 80 g/L
Patients with sickle cell disease presenting with any acute symptom or requiring surgery
Anemia associated with severe fatigue, chest discomfort, or impaired cognition
Serum ferritin > 10 000 µg/L
Bone fracture, osteolytic lesions, or hypercalcemia (features concerning for a plasma cell neoplasm, which can present emergently with spinal cord compression)
A suspected acute venous thrombotic event, or an acute arterial thrombotic event accompanied by erythrocytosis or thrombocytosis
