Haematology and oncology questions in the CICM Fellowship Exam have historically trended towards data interpretation. However, with the recent tendency to produce entirely new questions, past papers become a less dependable revision resource, and having a broad overview of the trending topics in a speciality becomes more important. What follows is a compilation of helpful papers, famous trials and society guidelines, drawing on other essential resources such as Critical Care Reviews and The Bottom Line. Wherever possible, the original paper is linked from the name of the study, and the Bottom Line review is linked from the year of publication.
Transfusion trials
TRICC - 1999 - what if Hb was 70? n=838 in Canada. No difference in mortality (18.7% vs 23.3%), unless you have active ischaemic heart disease
TRISS - 2014 - what if Hb 70, but in sepsis? n=998 in Scandinavia. No mortality difference (43% vs 45%)
TITRE2 - 2016 - what if Hb was 75 after cardiac surgery? n=2007 in the UK. No difference in weird composite outcome of infection and ischaemia: 35.1% vs 33.0%
PATCH - 2016 -platelets for ICH while on antiplatelets? n=190, in Europe. Increased death and dependence if you give platelets (mortality 32% vs 23%).
TRICS-III - 2017 - What if Hb was 70 after cardiac surgery? n=4860, all over the world. Not inferior in composites (12.3% vs 12.9%) - and was still non-inferior at 6 months
ITACTIC - 2020 - TEG/ROTEM vs. coags in trauma. Less product use? n=392 in Europe. No difference in product use; but also hardly any product use (only 67% and 36% of the groups got any blood products).
REALITY - 2021 - what if Hb 80, but in acute MI? n=666, in France and Spain. Lower Hb was not inferior (composite outcome 14% vs 11%)
Fresh human blood, vs. whatever is at the end of its expiry date
ABLE - 2015 - What if we used only "young"cells? n=2510 in Canada and Europe. No difference in mortality (37% vs 35%).
INFORM - 2016 - freshest vs oldest cells - n=20,859 all over the world, but not ICU patients. No difference in mortality (9.1% vs. 8.8%)
TRANSFUSE - 2017 - What if we used only "young"cells? n=4994 all over the world. No difference in mortality (24.8% vs 24.1%) unless high APACHE, in which case the fresher cells were for some reason worse (37.7% vs. 34%).
Iron infusion? Make your own damn cells
IRONMAN - 2016 - would 500 mg of ferric carboxymaltose reduce transfusion requirements in anaemic ICU patients? n=140 in Perth, Australia. It did not.
CRASH-2 - 2010 - what if we give TXA to trauma patients? n=20,207 all over the world. Improved mortality (14.5% vs 16%), but they weren't very bleedy (only 5% of patients actually died of haemorrhage)
CRASH-3 - 2019 - what if TXA, but in TBI? n=12737, all over the world. No mortality difference (18.5% vs 19.8%), no difference in DVT/PE (1.6% vs 1.6%). Signal for better mortality in mild-moderate TBI (5.8% vs 7.5%).
HALT-IT - 2020 - what if TXA, but in GI bleeding? n=12009, all over the world. No mortality difference (3.7% vs. 3.8%). More DVT/PE (0.8% vs. 0.4%).
ULTRA - 2021 - what if TXA, but in SAH? n=950 in Netherlands. No difference in good clinical outcome (60% vs 64%) but "excellent" outcome was much lower in the TXA group (48% vs 56%).
TRAAP2 - 2021 - what if TXA, but in caesarian section? n=4551 in France. Reduced PPH (26.7% vs 31.6%). Not much more DVT/PE (0.4% vs. 0.1%).
PATCH-Trauma - 2023 - what if TXA, but prehospital? n=1310, in Australia NZ and Germany. Significantly reduced mortality at 24 hrs and 28 days but there was no difference in good-functioning survival at 6 months (53.7% vs 53.5%).
Transfusion for bleeding in the critically ill
Transfusion for anaemia in the critically ill
Blood product administration, prescribing, storage, etc
Perioperative blood products, antiplatelets, anticoagulation
Anticoagulation reversal
VTE prophylaxis, diagnosis, management
HITS guidelines
Disseminated intravascular coagulation (DIC):
Thrombophilia testing
Miscellaneous haem/onc guidelines
Coagulopathy
Baksaas-Aasen, Kjersti, et al. "Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial." Intensive Care Medicine 47 (2021): 49-59.
Tranexamic acid trials
PATCH-Trauma Investigators and the ANZICS Clinical Trials Group. "Prehospital Tranexamic Acid for Severe Trauma." New England Journal of Medicine (2023).
Sentilhes, Loïc, Valérie Daniel, and Catherine Deneux-Tharaux. "TRAAP2-TRAnexamic Acid for Preventing postpartum hemorrhage after cesarean delivery: a multicenter randomized, doubleblind, placebo-controlled trial–a study protocol." BMC pregnancy and childbirth 20.1 (2020): 1-11.
Roberts, Ian, et al. "Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial." The Lancet 395.10241 (2020): 1927-1936.
CRASH-3 collaborators. "Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial." The Lancet 394.10210 (2019): 1713-1723.
Williams-Johnson, J. A., et al. "Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial." West Indian Medical Journal 59.6 (2010): 612.
Holst, Lars B., et al. "Lower versus higher hemoglobin threshold for transfusion in septic shock." New England Journal of Medicine 371.15 (2014): 1381-1391.
Hébert, Paul C., et al. "A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care." New England Journal of Medicine 340.6 (1999): 409-417.
Transfusion
Ducrocq, Gregory, et al. "Effect of a restrictive vs liberal blood transfusion strategy on major cardiovascular events among patients with acute myocardial infarction and anemia: the REALITY randomized clinical trial." Jama 325.6 (2021): 552-560.
Baharoglu, M. Irem, et al. "Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial." The Lancet 387.10038 (2016): 2605-2613.
Mazer, C. David, et al. "Restrictive or liberal red-cell transfusion for cardiac surgery." New England Journal of Medicine 377.22 (2017): 2133-2144.
Reeves, B., et al. "A multicentre randomised controlled trial of Transfusion Indication Threshold Reduction on transfusion rates, morbidity and health-care resource use following cardiac surgery (TITRe2)." Health Technology Assessment 20.60 (2016).
Cooper, D. James, et al. "Age of red cells for transfusion and outcomes in critically ill adults." New England Journal of Medicine 377.19 (2017): 1858-1867.
Lacroix, Jacques, et al. "Age of transfused blood in critically ill adults." New England Journal of Medicine 372.15 (2015): 1410-1418.
Heddle, Nancy M., et al. "Informing Fresh Versus Old Red Cell Management (INFORM) Trial: A Large International Pragmatic Randomized Trial." Transfusion. Vol. 56. 111 RIVER ST, HOBOKEN 07030-5774, NJ USA: WILEY-BLACKWELL, 2016.
IRONMAN Investigators, et al. "Intravenous iron or placebo for anaemia in intensive care: the IRONMAN multicentre randomized blinded trial: a randomized trial of IV iron in critical illness." Intensive care medicine 42 (2016): 1715-1722.
Guidelines
Levi, M., et al. "Guidelines for the diagnosis and management of disseminated intravascular coagulation." British journal of haematology 145.1 (2009): 24-33.
Di Nisio, Marcello, et al. "Diagnosis and treatment of disseminated intravascular coagulation: guidelines of the Italian Society for Haemostasis and Thrombosis (SISET)." Thrombosis research 129.5 (2012): e177-e184.
Wada, Hideo, et al. "Expert consensus for the treatment of disseminated intravascular coagulation in Japan." Thrombosis research 125.1 (2010): 6-11.
Wada, H., et al. "Guidance for diagnosis and treatment of disseminated intravascular coagulation from harmonization of the recommendations from three guidelines." Journal of thrombosis and haemostasis 11.4 (2013): 761-767.
Vlaar, Alexander P., et al. "Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine." Intensive Care Medicine 46 (2020): 673-696.
Carson, Jeffrey L., et al. "Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage." Jama 316.19 (2016): 2025-2035.
National Blood Authority. Patient Blood Management Guidelines. Module 4, Critical Care. National Blood Authority, 2012.
Keeling, David, et al. "Peri-operative management of anticoagulation and antiplatelet therapy." Br J Haematol 175.4 (2016): 602-613.
Kietaibl, Sibylle, et al. "Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care: Second update 2022." European Journal of Anaesthesiology| EJA 40.4 (2023): 226-304.
Arachchillage, Deepa J., et al. "Thrombophilia testing: a British Society for Haematology guideline." British Journal of Haematology 198.3 (2022): 443.
Middeldorp, Saskia, et al. "American Society of Hematology 2023 Guidelines for Management of Venous Thromboembolism: Thrombophilia Testing." Blood Advances (2023): bloodadvances-2023010177.
Tran, Huyen A., et al. "New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism." Medical journal of australia 210.5 (2019): 227-235.
Stevens, Scott M., et al. "Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report." Chest 160.6 (2021): e545-e608.
Joseph, Joanne, et al. "Diagnosis and management of heparin‐induced thrombocytopenia: a consensus statement from the Thrombosis and Haemostasis Society of Australia and New Zealand HIT Writing Group." Medical Journal of Australia 210.11 (2019): 509-516.
Tran, Huyen A., et al. "An update of consensus guidelines for warfarin reversal." Medical Journal of Australia 198.4 (2013): 198-199.
Jones, Gail L., et al. "Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology." British journal of haematology 169.5 (2015): 661-671.
Asherson, R. A., et al. "Catastrophic antiphospholipid syndrome: international consensus statement on classification criteria and treatment guidelines." Lupus 12.7 (2003): 530-534.