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.

Spontaneous coronary artery dissection (SCAD) is the formation of a false lumen within a vessel wall, with an accumulation of blood leading to vessel occlusion, mimicking symptoms of acute myocardial infarction (AMI). Here, we discuss the case of a middle-aged woman with STEMI who was found to have coronary artery dissection on coronary angiography during left heart catheterization. Clinicians should have a high suspicion of SCAD in young females presenting with AMI without traditional risk factors for coronary artery disease. Such patients should receive urgent angiography. Once the diagnosis is confirmed, there are no clear guidelines for treating AMI secondary to SCAD. Hemodynamically stable patients can be managed with the immediate initiation of antiplatelet therapy and beta-blockers. Thrombolytic therapy is avoided due to the risk of dissection and intramural hematoma. Coronary artery bypass graft (CABG) is indicated in patients with multiple vessel involvement or patients who have had a primary coronary intervention fail. Bioresorbable vascular scaffolds (BVS) may be a better option in STEMI or hemodynamic instability. However, current treatment strategies are based on expert opinion and a few case studies.

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.

Hairy cell leukemia (HCL) is an infrequently encountered chronic B-lymphocyte hematological malignancy, which is found to be more prevalent in males. HCL can present with a myriad of nonspecific symptoms involving the reticuloendothelial system. Usually, patients are diagnosed after an incidental finding of pancytopenia. In the majority of cases, HCL follows an indolent course, and many patients remain asymptomatic. Treatment with nucleoside analogs is the first line of treatment and is indicated for patients with severe anemia, thrombocytopenia, neutropenia, or severe systemic symptoms. Here, we report an atypical case of a 41-year-old Hispanic female who presented with menorrhagia and iron deficiency anemia. She was diagnosed with HCL after a bone marrow biopsy demonstrated the characteristic "hairy projections."