You have the ability to earn up to 0.5 CME credits per episode by listening to the CME on the Go series of Inside Family Medicine. In this episode, our co-hosts explore the complexities of managing hematologic emergencies in family medicine. They cover critical conditions such as profound anemia, thrombocytopenia, and coagulopathies, offering practical diagnostic strategies and treatment approaches.

Emphasizing the importance of restrictive transfusion strategies, setting appropriate hemoglobin thresholds, and understanding massive transfusion protocols, they discuss when to involve subspecialty support, particularly in cases like disseminated intravascular coagulation (DIC) and idiopathic thrombocytopenic purpura (ITP). The co-hosts share personal experiences and insights into leveraging advancements in medical technology and provide valuable tips to enhance patient care in family medicine settings.

Your co-hosts for the CME on the Go series are:

• Lauren Brown-Berchtold, MD, FAAFP, program director for the San Joaquin General Family Medicine Residency in French Camp, Calif.
• Jason Marker, MD, MPA, FAAFP, associate director of the Memorial Hospital Family Medicine Residency program in South Bend, Ind.
• Tamaan Osborne-Roberts, MD, MBA, FAAFP, chief medical officer and vice president of health strategy at the public sector health plan Colorado Access

Claiming Credit: After listening to the podcast episode, claim 0.5 AAFP credit by going to https://www.aafp.org/assessment/take/15291/e

Learning Objectives

1. Identify common hematologic emergencies encountered in primary care practice, such as thrombocytopenia, anemia, and coagulopathies.
2. Review the clinical presentation and diagnostic approach to hematologic emergencies.
3. Discuss initial management strategies, including transfusion therapy, pharmacologic interventions, and referral criteria for specialized care.

Topics by Timestamp

• 00:00 Welcome to CME On The Go
• 00:30 Meet the Hosts
• 01:55 Introduction to Hematologic Emergencies
• 03:13 Common Hematologic Emergencies
• 06:00 Transfusion Strategies and Protocols
• 11:55 Thrombocytopenia and ITP
• 17:51 DIC and Other Coagulopathies
• 21:46 Outpatient Considerations
• 23:13 Heavy Menstrual Bleeding and Potential Coagulopathy
• 28:39 Conclusion and Gratitude

References/ Resources

Diagnosis of abnormal uterine bleeding in reproductive-aged women: Practice Bulletin No. 128. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012;120:19 7–206.

UpToDate Article on RBC Transfusion Thresholds: UpToDate. (n.d.). Indications and hemoglobin thresholds for RBC transfusion in adults. Retrieved June 24, 2024, from https://www.uptodate.com/contents/indications-and-hemoglobin-thresholds-for-rbc-transfusion-in-adults

JAMA Article on Restrictive Threshold: JAMA Network. (n.d.). Restrictive threshold. Retrieved June 24, 2024, from https://jamanetwork.com/journals/jama/fullarticle/2810754#:~:text=Restrictive%20threshold%20

UpToDate Article on Massive Blood Transfusion: UpToDate. (n.d.). Massive blood transfusion. Retrieved June 24, 2024, from https://www.uptodate.com/contents/massive-blood-transfusion

AAFP Article on Postpartum Hemorrhage: American Academy of Family Physicians. (2020, July 1). Postpartum hemorrhage. Retrieved June 24, 2024, from https://www.aafp.org/pubs/afp/issues/2020/0701/p30.html

AAFP Practice Guidelines on Postpartum Hemorrhage: American Academy of Family Physicians. (2023, April). Practice guidelines: Postpartum hemorrhage. Retrieved June 24, 2024, from https://www.aafp.org/pubs/afp/issues/2023/0400/practice-guidelines-postpartum-hemorrhage.html

AAFP Article on Thrombocytopenia: American Academy of Family Physicians. (2022, September). Thrombocytopenia. Retrieved June 24, 2024, from https://www.aafp.org/pubs/afp/issues/2022/0900/thrombocytopenia.html

UpToDate Article on Diagnostic Approach to Thrombocytopenia: UpToDate. (n.d.). Diagnostic approach to thrombocytopenia in adults. Retrieved June 24, 2024, from https://www.uptodate.com/contents/diagnostic-approach-to-thrombocytopenia-in-adults

UpToDate Article on DIC in Adults: UpToDate. (n.d.). Evaluation and management of disseminated intravascular coagulation (DIC) in adults. Retrieved June 24, 2024, from https://www.uptodate.com/contents/evaluation-and-management-of-disseminated-intravascular-coagulation-dic-in-adults

UpToDate Article on Platelet Function Testing: UpToDate. (n.d.). Platelet function testing. Retrieved June 24, 2024, from https://www.uptodate.com/contents/platelet-function-testing

Disclosure: It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest and, if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.

All individuals in a position to control content for this session have indicated they have no relevant financial relationships to disclose.

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