Heme / blood bank
Hematology
Cytopenias, clots & transfusion. RI-first anemia, HIT 4Ts, TMA vs DIC, DOAC switching, and transfusion reactions.
01
Pancytopenia & Anemia classification
Always ask whether one process unifies all three lines or whether two independent cytopenias coexist.
Eashwar Somasundaram8 min6 Qs02
IDA, AOCD, megaloblastic anemia, AIHA & HLH
Oral iron: ferrous sulfate 325 mg every other day (Stoffel 2017) — consecutive dosing raises hepcidin and blocks absorption. Empty stomach ± vitamin C; calcium/antacids block it.
Eashwar Somasundaram6 min6 Qs03
Thrombocytopenia, ITP, HIT & TMA
Bleed risk: <50k surgery/active bleed, <30k mild trauma, <10k spontaneous. Confirm with a citrated platelet count to exclude EDTA clumping.
Julia Cohn8 min6 Qs04
Hypercoagulable states & coagulopathy
Do not send thrombophilia labs during acute VTE or on anticoagulation (APS and prothrombin gene are selective exceptions).
Julia Cohn6 min6 Qs05
Anticoagulation agents
Warfarin: INR lags 48 h. Life-threatening bleed: vitamin K 5–10 mg IV + 4F-PCC. INR >10 no bleed: PO vitamin K 2.5–5 mg.
Anna Crosetti7 min6 Qs06
Choosing & bridging anticoagulation
VTE: DOAC > warfarin > LMWH for most. Cancer: apixaban/edoxaban/rivaroxaban or LMWH; prefer LMWH if active GI/GU luminal tumor.
Anna Crosetti7 min6 Qs07
Transfusion medicine
Restrictive RBC trigger Hb <7 for most (TRICC). Cardiac surgery ~7.5 (TRICS). ACS may warrant 8–10 (MINT signal). Ortho/CAD historically <8.
Eashwar Somasundaram6 min6 Qs08
Transfusion modifications
Leukoreduction: ↓ HLA alloimmunization, ↓ CMV, ↓ febrile non-hemolytic reactions. Standard in most US units.
Eashwar Somasundaram6 min6 Qs09
Transfusion reactions
Stop the transfusion, keep IV open with saline, check the clerical identity, call the blood bank, send the remaining unit + post-transfusion labs (DAT, hemolysis labs, culture if febrile).
Eashwar Somasundaram5 min6 Qs