Thrombocytopenia is a common entity seen in ICU patients and is associated with increased morbidity such as bleeding and transfusions, and mortality in ICU patients. Various mechanisms such as decreased platelet production, sequestration, destruction, consumption, and sometimes a combination of these factors contribute to thrombocytopenia. An understanding of the mechanism is essential to diagnose the cause of thrombocytopenia and to help provide appropriate management. The management strategies are aimed at treating the underlying disorder, such as platelet transfusion to treat complications like bleeding. Several studies have aimed to provide the threshold for platelet transfusions in various clinical settings and recommend a conservative approach in the appropriate scenario. In this review, we discuss various pathophysiological mechanisms of thrombocytopenia and the diverse scenarios of thrombocytopenia encountered in the ICU setting to shed light on the varied thresholds for platelet transfusion, alternative agents to platelet transfusion, and future directions for the implementation of thromboelastography (TEG) in multiple clinical scenarios to assist in the administration of appropriate blood products to correct coagulopathy.

Background: Prostate cancer is a prevalent malignancy in males, particularly in older individuals and non-Hispanic Black men. Adenocarcinomas represent most prostate cancers, while other histological types are less common. Metastases from prostate cancer primarily involve bones and lymph nodes, with isolated lung and brain metastases being extremely uncommon. Understanding prostate cancer's clinical characteristics and behavior with atypical metastatic patterns is crucial for accurate diagnosis and optimal treatment strategies. Case Presentation: We present a case of a 60-year-old patient with high-grade Gleason prostate cancer, initially presenting with negative PSA levels. Despite the absence of bone involvement, the patient developed metastases to both the lung and brain, representing an unusual spread pattern. Detailed clinical features, imaging findings, diagnostic workup, and treatment interventions are described to provide a comprehensive understanding of this exceptional case. Conclusion: This case report highlights the rarity and clinical significance of prostate cancer metastases to the lung and brain without bone involvement. Isolated lung and brain metastases from prostate cancer are infrequent occurrences, and their diagnosis and management pose considerable challenges. Clinicians should be aware of these potential metastatic patterns, especially when encountering unusual clinical presentations or imaging findings in prostate cancer patients. Further research and case reports are warranted to enhance our knowledge of these rare metastatic events and optimize treatment approaches for patients with prostate cancer and atypical metastases.