Hematology, Hemostasis & Transfusion
Massive transfusion protocol, coagulopathy, DIC, HIT, and reversal of anticoagulation.
Core Topics
10 topicsMajor Bleeding, Hemorrhagic Shock, & Damage Control Resuscitation
The trauma lethal diamond (hypothermia, acidosis, coagulopathy, hypocalcemia), 1:1:1 massive transfusion (PROPPR trial), early TXA (CRASH-2), and TEG/ROTEM algorithms.
Disseminated Intravascular Coagulation (DIC) & Sepsis Coagulopathy
Tissue-factor-driven coagulation activation, antithrombin/protein C depletion, PAI-1-associated fibrinolytic suppression, ISTH 2025 DIC assessment, comparison with TTP/HUS/HIT, and targeted replacement.
Heparin-Induced Thrombocytopenia (HIT)
PF4-heparin antibody Fc-gamma-RIIa platelet activation, the 4Ts score, ELISA OD values vs Serotonin Release Assay (SRA), and direct thrombin inhibitor protocols.
Blood Product Transfusion in Critical Care
Patient-specific RBC transfusion thresholds, current platelet/procedural thresholds, plasma/cryoprecipitate use, and the TRALI vs TACO diagnostic matrix.
Therapeutic Anticoagulation & Emergency Reversal in the ICU
UFH vs LMWH vs DTIs (Argatroban/Bivalirudin), anti-Xa vs aPTT monitoring, and emergency reversal (Protamine, 4F-PCC, Idarucizumab; historical andexanet evidence with current availability caveats).
Thrombotic Thrombocytopenic Purpura (TTP)
Recognition of thrombotic microangiopathy, PLASMIC risk, ADAMTS13 testing, immediate plasma exchange, steroids, caplacizumab, and ICU complications.
Immune Thrombocytopenia (ITP)
ICU approach to isolated immune thrombocytopenia, bleeding severity, IVIG/steroids, platelet transfusion in critical bleeding, and rescue therapy.
Tumor Lysis Syndrome
Risk-stratified prevention and ICU treatment of tumor lysis syndrome with hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia and AKI.
HLH / Macrophage Activation Syndrome
Adult ICU recognition, trigger investigation and individualized treatment of hemophagocytic lymphohistiocytosis/macrophage activation syndrome.
TEG / ROTEM & Viscoelastic Hemostasis
Read whole-blood clot initiation, propagation, firmness and lysis without treating device-specific values as universal transfusion orders.
Clinical Problems & Bedside Triage
12 guidesNew or Massive Hemoptysis
Airway preservation and bleeding localization: non-massive vs massive hemoptysis (> 100–200 mL/hr), lateral decubitus positioning, isolation of the bleeding lung, and endovascular/bronchoscopic intervention.
Acute Hypotension & Undifferentiated Shock
Rapid bedside hemodynamic categorization: confirming MAP < 65 mmHg, assessing peripheral perfusion, POCUS cardiac/IVC profiling, and differentiating hypovolemic, distributive, cardiogenic, and obstructive etiologies.
New Focal Neurologic Deficit in the ICU
Rapid code-stroke protocol in critical illness: emergent non-contrast CT and CTA, distinguishing acute ischemic stroke (LVO candidate) from intracranial hemorrhage, and managing post-procedural neurological loss.
Suspected Sepsis & Early Septic Shock
SSC 2026 sepsis recognition and resuscitation: rapid infection-likelihood assessment, timely antimicrobials, individualized initial crystalloids, early norepinephrine, serial perfusion reassessment, and source control.
Acute Bleeding & Falling Hemoglobin
Bedside triage of acute blood loss: active hemorrhage vs occult bleeding vs hemodilution, context-specific RBC thresholds, protocolized massive-hemorrhage resuscitation, targeted component therapy, and anticoagulant reversal.
New Thrombocytopenia & Coagulopathy in the ICU
Differential diagnosis of acute platelet drops and clotting derangements: 4Ts-based HIT assessment, dynamic disease-specific DIC scoring, recognition of thrombotic microangiopathy/TTP, and targeted replacement or anticoagulant therapy.
Critically Ill Pregnant or Postpartum Patient
Maternal-first stabilization with rapid differentiation of hypertensive, hemorrhagic, thromboembolic, septic, hepatic and cardiac obstetric emergencies.
Thrombocytopenia + Hemolysis + Organ Injury
Recognize a thrombotic microangiopathy, estimate the probability of immune TTP, obtain ADAMTS13 before plasma therapy when feasible, and start time-critical TTP treatment without waiting for the result when suspicion is high.
Critical Bleeding with Severe Thrombocytopenia
Stabilize hemorrhage while distinguishing immune destruction, consumption and microangiopathy.
Cancer Patient with Abrupt Electrolyte Collapse
Hyperkalemia, hyperphosphatemia, hypocalcemia and AKI around cancer therapy.
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.
Life-Threatening Upper GI Bleeding
Airway-aware resuscitation, variceal vs nonvariceal phenotype, urgent endoscopic hemostasis, and escalation to IR/TIPS/surgery when bleeding remains uncontrolled.
Clinical Reasoning Cases
14 casesHypertensive Acute Pulmonary Edema (SCAPE Phenotype)
Rapid ventilatory support and afterload reduction in flash pulmonary edema
Severe Hyperkalemia with Cardiac Toxicity
Membrane stabilization, intracellular shifting, monitoring, and definitive potassium removal
High-Risk Pulmonary Embolism with Obstructive Shock
RV perfusion support, rapid reperfusion selection, and high-risk airway management
Auto-PEEP & Dynamic Hyperinflation Shock
Post-intubation obstructive shock from severe gas trapping
Acute Intracranial Hypertension Crisis
Tiered management of intracranial hypertension after severe traumatic brain injury
Severe Metabolic Alkalosis After Massive Transfusion
Mechanism-based management of severe alkalemia, electrolyte abnormalities, and volume overload
Persistent MRSA Bacteremia
Source-control reassessment and salvage therapy for persistent Staphylococcus aureus bloodstream infection
Disseminated Intravascular Coagulation
Competing hemorrhagic and thrombotic physiology in postpartum hemorrhage and sepsis
Immune Thrombotic Thrombocytopenic Purpura
Immediate recognition, ADAMTS13 testing, plasma exchange, and caplacizumab-based therapy
Cardiogenic Shock: Competing Therapies
Balancing pressure support, inotropy, congestion, and temporary MCS
Occult Hemorrhagic Shock
Early recognition, damage-control resuscitation, and rapid hemorrhage control
Mechanical Mitral Valve with Intracerebral Hemorrhage
Emergency VKA reversal followed by individualized anticoagulation resumption