Book Review

Hematologic and Oncologic Emergencies

N Engl J Med 1994; 330:1164-1165April 21, 1994

Article

Hematologic and Oncologic Emergencies
Edited by William R. Bell. 253 pp. New York, Churchill Livingstone, 1993. $65. ISBN: 0-443-08871-3

The amount of information important to the care of patients with hematologic and oncologic disease has expanded to the extent that standard textbooks encompassing these fields need a minimum of two volumes and over 4000 pages to cover the basics. This ever-increasing knowledge base has led to two trends in publication. On the one hand, comprehensive subspecialty textbooks in fields such as transfusion medicine or hemostasis provide in-depth information needed by the researcher or practitioner with a subspecialty interest. On the other hand, shorter books with a more general focus present reviews or emphasize practical clinical management. Hematologic and Oncologic Emergencies is of the latter type, focusing on the diagnosis and management of more frequently encountered emergencies in hematology and oncology.

The editor, Bell, a leader in the field of hemostasis, has solicited 10 chapters from physicians with clinical experience. The book aims “to identify the most practical methods that should be employed to quickly and correctly identify various hematologic and oncologic emergencies and to enable their optimal expedient management,” while “maintaining a balance between the most recent scientific knowledge applicable to the situation and the most practical clinical approach.” This theme reflects the choice of topics: seven chapters focus on management problems such as bleeding, acute hemolytic disorders, massive transfusion, and disseminated intravascular coagulation, whereas only three deal with specific diseases -- idiopathic thrombocytopenic purpura, sickle cell disease, and thrombotic thrombocytopenic purpura. Only a single chapter discusses acute complications of neoplasia and their management. In keeping with the book's purpose, there are no chapters about the choice of chemotherapy or other issues in long-term care.

A distinctly positive feature of this book is its brevity, only 253 pages; most chapters are concise and clear, focusing on practical management. For example, the chapter on disseminated intravascular coagulation presents a focused and logical approach to the diagnosis and management of this complex syndrome. The single chapter on acute complications of neoplasia succinctly discusses a useful approach to such important and frequent problems as the superior vena cava syndrome, malignant pericardial effusions, hypercalcemia, tumor lysis syndrome, spinal-cord compression, and febrile neutropenia. I found, however, that the emphasis varied greatly among the chapters. For example, the chapter on acute hemolytic disease provides an overall review of the topic, extensive discussion of differential diagnosis, and an extensive bibliography of 213 references, but little practical advice. This chapter contrasts with the short one on sickle cell disease, which focuses entirely on management in the emergency department, is very practical, and contains only 14 references. Certain omissions deserve mention. For example, there was no chapter on thrombotic disease, although hematologists are often asked to help with anticoagulant or fibrinolytic therapy. Also, considering that patients with malignant disease represent a large proportion of those seen by hematologists and oncologists, a greater emphasis on their care would have added to the book. For example, guidelines for managing rapidly proliferating tumors such as high-grade lymphomas and leukemias would have been helpful.

Most hematologists and oncologists will be familiar with the management of the problems discussed in this textbook and choose to refer to a more detailed source for information. This book may, however, be useful to medical residents as well as internists and emergency room physicians who encounter patients with hematologic and oncologic emergencies and do not want to search through the thousands of pages in standard textbooks to find a useful approach to management.

Charles W. Francis, M.D.
University of Rochester School of Medicine and Dentistry, Rochester, NY 14642