Leukaemia & Lymphoma in the ED
Leukaemia and lymphoma commonly present to the emergency department with complications of the disease or its treatment rather than for definitive diagnosis. The ED role is rapid recognition, initial stabilisation, targeted investigations, early treatment of life‑threatening complications and immediate liaison with haematology/oncology.
This section summarises practical ED‑facing guidance, aligned with NICE suspected cancer and neutropenic sepsis recommendations (NICE NG12, NG52, CG151) and recent safety advice on tumour lysis risk with targeted agents (e.g. venetoclax).
Clinical scope - what to look for
- Presentations most commonly seen in ED: febrile neutropenia, sepsis, tumour lysis syndrome (TLS), leukostasis, bleeding or thrombosis from coagulopathy, airway or vascular compression from bulky lymphadenopathy/mediastinal mass, symptomatic anaemia, and complications of indwelling catheters.
- Always ask about current or recent anticancer therapy (chemotherapy, immunotherapy, targeted agents such as venetoclax) and recent blood counts - this alters risk stratification for neutropenic sepsis and TLS (NICE CG151; MHRA venetoclax alert).
A brief practical classification (ED view)
- Acute leukaemia (AML, ALL): rapid onset, marrow failure, high risk of infection, TLS and leukostasis. In ED, AML and ALL are managed similarly initially.
- Chronic leukaemia (e.g. CML): often indolent but can present acutely with complications.
- Lymphoma (Hodgkin, non‑Hodgkin): usually nodal/mass disease causing local effects (e.g. SVC obstruction, airway compromise) but can “spill” into blood.
- Diagnostic overlap is common;...