Week of 27 July – 2 August 2026¶
What are thrombotic microangiopathies?¶
Answer: TMAs are a diverse group of diseases that manifest (or are defined by) microangiopathic hemolytic anemia (DAT-negative hemolysis), thrombocytopenia, and end-organ damage.
- Primary causes: inherited ADAMTS13 deficiency (congenital TTP, cTTP) and acquired ADAMTS13 deficiency (immune TTP, iTTP), plus STEC-HUS.
- Secondary causes: e.g. HELLP and systemic cancer.
- Recognition of a TMA is important because prompt treatment may reverse organ injury and improve morbidity and mortality.
- The most important TMA to learn is immune TTP, because immediate PLEX is standard of care and treatment should not be delayed.
Source: Syndromes of Thrombotic Microangiopathy
How do you treat severe anemia in individuals who cannot receive blood products?¶
Answer: It depends on the clinical presentation.
- For all: improve iron, B12, and folic acid stores; limit phlebotomies; and consider early use of an ESA.
- Acute and chronic bleeding: focus on source control.
- Operative management:
- Screen and treat anemia.
- Discuss in detail which blood products would be considered acceptable, and document this in the chart.
- Discuss strategies to lower blood loss with anesthesia and surgery (Cell Saver, etc.).
- Use pediatric tubes for phlebotomy.
- Add an EMR alert.
Source: Treatment of individuals who cannot receive blood products for religious or other reasons
Outline an approach to neutropenia for acutely ill patients who present to hospital with a normal CBC.¶
Answer: The most common causes of neutropenia in hospitalized patients are medication-related (antibiotics, chemotherapy, etc.) and acute illness/infection.
- Treatment is largely expectant — address the underlying cause or provide G-CSF support.
- See The Blood Project for a general approach to isolated neutropenia.
Source: Approach to Isolated Neutropenia — The Blood Project
Where can I find a comprehensive review of sickle cell disease?¶
Answer: For a comprehensive overview of sickle cell disease, see this NEJM review.
Source: Sickle Cell Disease