24. Thrombocytopenia with Dr. Matthew Rendo, MD.

This episode of Critical Care Time delves into thrombocytopenia, exploring the physiology, causes, and treatments of low platelet counts in critically ill patients. Dr. Matt Rendo, a hematology and oncology expert, joins hosts Dr. Cyrus Askin and Dr. Nick Mark to discuss platelet production, destruction, and sequestration. The conversation covers diagnostic approaches like the 4T score for heparin-induced thrombocytopenia (HIT) and the ADAMTS-13 assay for thrombotic thrombocytopenic purpura (TTP). The doctors emphasize tailored transfusion strategies based on bleeding risk and underlying conditions, cautioning against reflexive transfusions in immune-mediated cases. Real-world cases illustrate nuances in managing thrombocytopenia related to sepsis, HIT, cirrhosis, and thrombotic microangiopathies, highlighting the importance of considering both thrombotic and bleeding risks.

Outlines

Part 1: Basics, Definitions, and Mechanisms

Part 2: Transfusion Guidelines and Sepsis

Part 3: Heparin-Induced Thrombocytopenia (HIT)

Part 4: Cirrhosis and Coagulopathy

Part 5: Microangiopathic Hemolytic Anemia (TTP, HUS)

Part 6: Advanced Management and Clinical Pearls

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Critical Care Time

Part 1: Basics, Definitions, and Mechanisms

Introduction to Thrombocytopenia and Guest Dr. Matt Rendo

Platelets Defined: Function, Production, and Clinical Significance

Thromboelastography (TEG) and Overview of Thrombocytopenia Causes

Deep Dive into Thrombocytopenia Causes: Destruction, Production, Sequestration

Part 2: Transfusion Guidelines and Sepsis

Platelet Transfusion Guidelines and the Interplay of Coagulation Factors

Sepsis-Induced Thrombocytopenia: Diagnosis, Prevalence, and Drug-Induced Considerations

Part 3: Heparin-Induced Thrombocytopenia (HIT)

Heparin-Induced Thrombocytopenia (HIT): Diagnosis, Pathophysiology, and Risk Factors

HIT Treatment, Fondaparinux Use, and Differential Diagnoses

HIT Incidence, Risk Factors, and Cirrhosis-Related Thrombocytopenia

Part 4: Cirrhosis and Coagulopathy

Cirrhosis Coagulopathy: Bleeding vs. Clotting and the Role of TEG

Part 5: Microangiopathic Hemolytic Anemia (TTP, HUS)

Thrombotic Thrombocytopenic Purpura (TTP): Initial Assessment and Differential Diagnosis

TTP Diagnosis: ADAMTS-13 Assay, Plasmic Score, and Treatment Urgency

TTP Treatment: Plasma Exchange, Steroids, Rituximab, and Caplacizumab

Shiga Toxin-Mediated Hemolytic Uremic Syndrome (ST-HUS)

Part 6: Advanced Management and Clinical Pearls

Complement-Mediated Thrombotic Microangiopathy and Potpourri: DVT Prophylaxis

Potpourri: Transfusion Thresholds in Blood Cancers and Platelet-Stimulating Agents

24. Thrombocytopenia with Dr. Matthew Rendo, MD.

Critical Care Time

Part 1: Basics, Definitions, and Mechanisms

00:19Introduction to Thrombocytopenia and Guest Dr. Matt Rendo

Introduction to Thrombocytopenia and Guest Dr. Matt Rendo

04:43Platelets Defined: Function, Production, and Clinical Significance

Platelets Defined: Function, Production, and Clinical Significance

12:12Thromboelastography (TEG) and Overview of Thrombocytopenia Causes

Thromboelastography (TEG) and Overview of Thrombocytopenia Causes

16:49Deep Dive into Thrombocytopenia Causes: Destruction, Production, Sequestration

Deep Dive into Thrombocytopenia Causes: Destruction, Production, Sequestration

Part 2: Transfusion Guidelines and Sepsis

25:39Platelet Transfusion Guidelines and the Interplay of Coagulation Factors

Platelet Transfusion Guidelines and the Interplay of Coagulation Factors

31:46Sepsis-Induced Thrombocytopenia: Diagnosis, Prevalence, and Drug-Induced Considerations

Sepsis-Induced Thrombocytopenia: Diagnosis, Prevalence, and Drug-Induced Considerations

Part 3: Heparin-Induced Thrombocytopenia (HIT)

37:53Heparin-Induced Thrombocytopenia (HIT): Diagnosis, Pathophysiology, and Risk Factors

Heparin-Induced Thrombocytopenia (HIT): Diagnosis, Pathophysiology, and Risk Factors

45:11HIT Treatment, Fondaparinux Use, and Differential Diagnoses

HIT Treatment, Fondaparinux Use, and Differential Diagnoses

51:11HIT Incidence, Risk Factors, and Cirrhosis-Related Thrombocytopenia

HIT Incidence, Risk Factors, and Cirrhosis-Related Thrombocytopenia

Part 4: Cirrhosis and Coagulopathy

57:05Cirrhosis Coagulopathy: Bleeding vs. Clotting and the Role of TEG

Cirrhosis Coagulopathy: Bleeding vs. Clotting and the Role of TEG

Part 5: Microangiopathic Hemolytic Anemia (TTP, HUS)

1:03:43Thrombotic Thrombocytopenic Purpura (TTP): Initial Assessment and Differential Diagnosis

Thrombotic Thrombocytopenic Purpura (TTP): Initial Assessment and Differential Diagnosis

1:11:15TTP Diagnosis: ADAMTS-13 Assay, Plasmic Score, and Treatment Urgency

TTP Diagnosis: ADAMTS-13 Assay, Plasmic Score, and Treatment Urgency

1:17:07TTP Treatment: Plasma Exchange, Steroids, Rituximab, and Caplacizumab

TTP Treatment: Plasma Exchange, Steroids, Rituximab, and Caplacizumab

1:25:00Shiga Toxin-Mediated Hemolytic Uremic Syndrome (ST-HUS)

Shiga Toxin-Mediated Hemolytic Uremic Syndrome (ST-HUS)

Part 6: Advanced Management and Clinical Pearls

1:27:11Complement-Mediated Thrombotic Microangiopathy and Potpourri: DVT Prophylaxis

Complement-Mediated Thrombotic Microangiopathy and Potpourri: DVT Prophylaxis

1:34:21Potpourri: Transfusion Thresholds in Blood Cancers and Platelet-Stimulating Agents

Potpourri: Transfusion Thresholds in Blood Cancers and Platelet-Stimulating Agents