Medical Hematology & Vascular Emergencies

Mike B

18d • Paramedic Talk

Sickle Cell Disease

What it is:

Genetic disorder causing abnormal hemoglobin → RBCs become rigid and sickle-shaped

Why it matters:

Sickled cells block blood flow → ischemia and pain
Repeated infarction damages organs

High-Yield Complication

Splenic infarction → increased infection risk

The spleen can also enlarge and rupture (splenic sequestration crisis)

Presentation

Severe pain (vaso-occlusive crisis)
Fever (infection risk)
Signs of anemia

EMS Management

Oxygen
Pain control
IV fluids
Treat infections early

NREMT Pearl: Sickle cell → think spleen + infection risk

Marfan Syndrome

What it is:

Connective tissue disorder affecting fibrillin

Key Features (MEMORIZE)

Tall, thin body habitus
Long extremities
Joint laxity

Why it matters (CRITICAL)

Weak connective tissue → aortic dilation → risk of dissection

NREMT Pearl: Marfan = risk for aortic dissection

Aortic Dissection

What it is:

Tear in the inner layer of the aorta → blood separates vessel layers

Classic Presentation (MEMORIZE)

Sudden, severe chest pain
“Tearing” or “ripping” pain
Radiates to the back

Additional Clues

Unequal blood pressures between arms
Pulse deficits

Life Threat:

Rapid internal bleeding → death

EMS Management

Control BP (per protocol)
Oxygen
Rapid transport

NREMT Pearl: Tearing chest pain to the back = dissection

Leukemia & Infection Risk

What it is:

Cancer of blood-forming tissues → abnormal WBC production

Why patients get more infections:

Bone marrow produces immature/nonfunctional white blood cells

Result:

Poor immune response
High susceptibility to infection

NREMT Pearl: Leukemia ≠ strong immune system → high infection risk

Blood Transfusion Reactions

Overview:

Reactions can occur during or shortly after transfusion

Common Types

Febrile Reaction

Fever
Chills

Allergic Reaction

Rash
Itching
Urticaria

Hemolytic Reaction (MOST SERIOUS)

Fever
Back pain
Hypotension
Hemoglobin breakdown

CRITICAL EMS RESPONSE (MEMORIZE)

If patient develops: Dyspnea + flushing (or any reaction)

Immediate Actions:

STOP the transfusion immediately
Maintain IV access with normal saline
Monitor vital signs
Support airway and breathing
Notify receiving facility/physician

NREMT Pearl: Any reaction → STOP transfusion FIRST

Summary

Sickle cell → spleen damage/rupture + infection risk
Marfan → weak connective tissue → aortic dissection risk
Aortic dissection → tearing chest pain to back
Leukemia → nonfunctional WBCs → infections
Transfusion reaction → STOP transfusion immediately

NREMT Test Strategy

Identify underlying pathology Blood disorder → infection or clotting issue Connective tissue → vascular rupture risk
Recognize life threats quickly Dissection Hemolytic reaction Splenic rupture
Choose priority action Stop transfusion Support airway Rapid transport

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