ICU Map

HLH / Macrophage Activation Syndrome — ICU Decision Pathway

ICU recognition of hyperinflammatory HLH/MAS, differentiation from sepsis and urgent trigger-directed immunomodulatory treatment.

RecognizeAssessDecideDifferentialInterveneReassess
Hyperinflammatory Shock with Cytopenias
Assessment StepThink HLH when 'sepsis' has disproportionate hyperinflammationExplore Topic
Persistent fever, cytopenias, hepatitis, splenomegaly, coagulopathy/hypofibrinogenemia, hypertriglyceridemia and very high ferritin should raise suspicion, especially with malignancy, EBV or rheumatologic triggers.
Clinical ActionUse HLH-2004 features and HScore as supports, not substitutes for judgment
No single ferritin threshold diagnoses adult HLH. Serial pattern, organ involvement and the clinical context matter; bone-marrow hemophagocytosis is neither required nor specific.
Reassessment / LoopReassess response and escalate
Trend physiology and organ function; if the patient is worsening, revisit diagnosis, source control and rescue options rather than repeating ineffective therapy.

An educational representation of clinical reasoning, not a diagnostic algorithm or personalized medical advice — always apply clinical judgment and institutional protocols.

Caution

Escalate — Red Flags & Critical Warnings

  • Escalate early for shock, rapidly progressive organ failure, dangerous ECG/airway findings or failure of initial therapy.

Related Bedside Clinical Problems (1)

Bedside Presentations
Hyperinflammatory Shock with Cytopenias / Suspected Adult HLH

Sepsis-like multiorgan failure with fever, cytopenias, hepatitis/coagulopathy and hyperinflammation requiring structured HLH assessment, trigger search and early hematology-directed treatment.

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Linked Deep-Dive Topics (1)

Reference Knowledge
HLH / Macrophage Activation Syndromehematology

Adult ICU recognition, trigger investigation and individualized treatment of hemophagocytic lymphohistiocytosis/macrophage activation syndrome.

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Evidence status

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