الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Hematologic disorders are frequently encountered in the intensive care
unit, which include anemia, coagulation disorders, hematological
malignancies and eosinophil disorders.
Anemia often develops early in the course of a critical illness. The
causes of anemia in ICU include blood loss, blunted erythropoietin
response, inflammation and increased RBCs destruction.
The established method for managing anaemia in the ICU is allogeneic
red cell transfusion. The key question in deciding how to use red cell
transfusion in the ICU is identifying the most appropriate transfusion
trigger and the target haemoglobin range for each patient.
Recombinant human erythropoietin (rHuEPO) may represent a
therapeutic option for the treatment of anemia of critical illness and an
additional way to conserve RBCs in the ICU.
Coagulation disorders are commonly found in critically ill patients.
They include bleeding disorders (hemorrhagic disorders) and clotting
disorders (thrombotic disorders or hypercoagulable states).
Hypercoagulable states can be defined as a group of inherited or
acquired conditions associated with a predisposition to venous thrombosis
(including upper and lower extremity deep venous thrombosis (DVT)
with or without pulmonary embolism (PE), cerebral venous thrombosis,
and intra-abdominal venous thrombosis), arterial thrombosis (including
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myocardial infarction, stroke, acute limb ischemia, and splanchnic
ischemia), or both.
Bleeding disorders can arise from disorders of the coagulation system,
platelets and vessel wall.
The most common bleeding disorders in ICU is acute traumatic
hemorrhage. Massive haemorrhage has been reported to account for up to
50% of all trauma-related deaths. In addition to blood loss alone,
haemorrhage produces a cascade of three key physiological interactions
encapsulated by the term the “lethal triad”. It is this combination of
coagulopathy, hypothermia and acidosis that results in a global
haemostatic deficit, increasing the risk of exsanguination.
Damage control resuscitation (DCR) is a treatment strategy that
targets the conditions that exacerbate hemorrhage in trauma patients.
DCR differs from current resuscitation approaches by attempting an
earlier and more aggressive correction of coagulopathy and metabolic
derangement.
Thrombocytopenia is very common in critically ill patients treated
in the intensive care unit (ICU).
Thrombocytopenia in the ICU is caused by many causes such as
immune-medicated thrombocytopenia, drugs or toxins, intra-aortic
balloon pump/intravascular device use, hypersplenism and
microangiopathic hemolytic anemia as DIC.
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DIC is common in ICU patients, as it is a comorbidity of many of the
diagnoses, which lead to ICU admission. While DIC is not a primary
disorder, it is a marker of an underlying systemic process.
Treatment of DIC is treatment of the underlying disorder aggressively,
restoration of adequate circulatory volume and coagulation potential as
quickly as possible.
Patients with haematological malignancy may develop critical illness
either as part of their first presentation with the malignancy or more
commonly after chemotherapy or haematopoietic stem cell transplant
(HSCT).
ICU admission for patients with haematological malignancies, and
particularly after bone marrow transplantation, has been associated with
very poor outcomes, and in some cases, critical care has been withheld
because it was perceived to be futile. Newer studies suggest that ICU
outcomes have improved, probably as a result of changes in both
haematological treatments and ICU care.
The normal eosinophil count in the peripheral blood ranges from 50 to
500 × 109/l. Blood eosinophilia can be divided into mild eosinophilia (up
to 1500 × 109/l) and marked eosinophilia (>1500 × 109/l).
Eosinophils and their products play an essential role in the
pathogenesis of various reactive and neoplastic disorders. Early
therapeutic intervention with agents reducing eosinophil counts can be
effective in limiting or preventing irreversible organ damage