Hematology and Oncology

Coagulopathy, thrombosis, and other hematological abnormalities are common in the pediatric intensive care unit . Current guidelines recommend red blood cell transfusion for a hemoglobin concentration less than 7 g/dL in critically ill, hemodynamically stable patients; platelets for a concentration less than 10,000 in nonbleeding patients; and cryoprecipitate in bleeding patients for fibrinogen values less than 100 to 150 mg/dL. Massive transfusion protocols that push blood products to the bedside are more practical than reactive protocols. Transfusion reactions include transfusion-associated acute lung injury and transfusion-associated circulatory overload. Hematologic crises in the PICU are commonly complications of other primary disorders. Sickle cell disease may lead to acute chest syndrome, sequestration crisis, and stroke, and require aggressive intervention. Oncological diseases produce hyperleukocytosis, tumor lysis syndrome, veno-occlusive disease, graft-versus-host disease, and sepsis in association with leukopenia. A relatively newly recognized disorder, hemophagocytic lymphohistiocytosis, requires early recognition and treatment to avoid adverse outcomes.