Step into the macrocytic anemia caboose and remember the non-megaloblastic causes with the mnemonic My Liver Bleeds a Lot:

• My → Multiple Myeloma (CRAB: Hypercalcemia, Renal failure, Anemia, Bone lesions)

• Liver → Liver disease

• Bleeds → Hemolysis

• A → Alcohol use

• Lot → Hypothyroidism

We start at the front half of the caboose with the non-megaloblastic nun holding a sign with crossed-out “mega” dynamite, marking the absence of hypersegmented neutrophils. The kingpin character raises an alcohol bottle (liver logo) in a toast—reminding us of alcohol as a cause—bumping it into his tuxedo labeled “TSH > 10” for hypothyroidism. Above him, three red balloons drip a drop of blood onto the liver logo, tying in the phrase “My liver bleeds a lot.”

In the back half of the caboose, the B12 sumo baby wears a bandanna labeled “MMA” for methylmalonic acid (elevated in B12 deficiency), reaching up toward a Sistine Chapel ceiling to touch a finger labeled “↑ homocysteine” (seen in both folate and B12 deficiency). These back-half characters remind us that megaloblastic macrocytosis does have hypersegmented neutrophils, and is tied to DNA synthesis problems.

For alcohol-related macrocytosis, we recall Wernicke’s encephalopathy—classic triad:

1. Ophthalmoplegia (eye movement abnormalities)

2. Ataxia (gait disturbance)

3. Confusion (altered mental status)

ED Application:

• In AMS + alcohol use, always give thiamine before glucose to prevent progression to Korsakoff syndrome (confabulation, severe memory deficits).

• Macrocytosis without anemia can be an early alcohol toxicity sign—screen for liver disease, nutritional deficiencies, hypothyroidism, and myeloma.

• Suspect multiple myeloma? Check calcium, renal function, Hgb, and order imaging for bone lesions.

• Non-megaloblastic macrocytosis = treat underlying cause (alcohol cessation, thyroid replacement, liver management, transfusion for hemolysis).

• Megaloblastic macrocytosis = give B12/folate; avoid masking B12 deficiency with folate alone to prevent neurologic damage.

In the fast-paced, high-stakes world of emergency medicine, every second matters—especially when it comes to sickle cell crisis.

This podcast takes you straight to the heart of what matters most for ED clinicians, walking you through the essential “4 R’s” that can mean the difference between stabilization and rapid deterioration:

• Recognize — Identify the telltale signs of sickle cell crises early. Understand presentations like acute pain episodes, acute chest syndrome, stroke, and splenic sequestration, and learn how to differentiate these from other causes of acute pain or respiratory distress.

• Reverse — Act fast to correct life-threatening complications. From oxygen and aggressive IV fluids to urgent infection management, you’ll get evidence-based, bedside-ready strategies to halt progression.

• Radiology — Know when and why to image. From chest X-rays in acute chest syndrome to brain imaging for suspected stroke, we’ll break down which modalities to order—and how to interpret findings in the sickle cell patient.

• Refer — Recognize when escalation of care is critical. Whether to hematology, critical care, or transfer to a higher-level facility, we’ll cover the decision-making process and timing.

Hosted with a focus on clinically relevant, ED-ready pearls, each episode blends:

• Case-based storytelling — Putting you in the room with the patient, step-by-step.

• Mnemonic-rich recall tools — Like our “crime scene outline” visual, with key stickers marking the 4 R’s across the patient’s limbs for fast memory anchoring.

• Practical takeaways — What you can do immediately, what you must watch for, and what to avoid.

The principles behind the Sickle Cell 4 R’s is delivered in a no-fluff, high-yield format designed for busy clinicians who want to sharpen their edge in real emergencies.

Whether you’re a seasoned emergency medicine provider, a resident looking to solidify your sickle cell knowledge, or simply someone passionate about critical care, Sickle Cell Crisis: The 4 R’s will give you the skills and confidence to take decisive action when it matters most.

Hemolytic Anemias Mnemonic for the ED: TAG MY SUITCASE

In this high‑impact episode of Emergency Medicine Mind Palace, we break down hemolytic anemias into a memorable 5‑suitcase system that will stick with you on your next shift.

If you’ve ever seen dark urine, anemia, or dropping hemoglobin and felt that twinge of uncertainty about which hemolytic process is at play, this episode will lock in the key visual cues and ED actions you need to recall under pressure.

We explore the TAG MY SUITCASE mnemonic, where each suitcase represents a dangerous hemolytic anemia type:

T → Thrombocytopenia suitcase (TTP / HUS / ITP / DIC / HELLP / HIT)

• VW slug bug sticker with TTP & HUS clues

• ITP “plate on the road” visual

• DIC, HELLP, and HIT taped reminders

• ED takeaway: These can kill fast—recognize the pentad, check for microangiopathic hemolysis, and know when to call heme & transfuse.

A → Autoimmune hemolysis suitcase (Warm & Cold)

• Warm side: Sun with spleen + IgG, holding butterfly (lupus) & RX bottle (drug‑induced)

• Cold side: Blue hand with IgM, complement‑mediated, “cold agglutinin” with a tiny microphone (think Mycoplasma)

• ED takeaway: Identify warm vs. cold; call heme; avoid cold exposure; supportive care first.

G → G6PD suitcase (G6 Police Department)

• Police badge, radical sticker with O₂ radicals attacking RBCs

• Fava beans & Heinz ketchup with a bitten lid (Heinz bodies, bite cells)

• ED takeaway: Stop the offending agent—the “police arrest the radicals.” Supportive transfusion only if unstable.

M → Mechanical / ECMO suitcase (Sales Rep)

• Heart valve + ECMO plush lung

• Cola urine bottle (hemoglobinuria) & cardiology business card

• ED takeaway: Shear stress causes hemolysis; check urine, hemolysis labs, MAP not pulse; coordinate with cardiology/CT surgery.

S → Sickle Cell suitcase (Crime Scene Outline)

• White briefcase with faint crescent RBC pattern

• The 4 R’s for ED management:

1. Recognize – Sickle crisis & life‑threatening complications

2. Reverse – Pain control, oxygen, fluids, antibiotics (Uno reverse card sticker)

3. Radiology – Targeted imaging: CT head, CXR→CT chest, CTA limb, priapism eval

4. Refer – Heme, Neuro, Vascular, Urology early

• X marks on chest, brain, leg, pelvis: Acute Chest, Stroke, Limb Ischemia, Priapism

⸻

By the end of this episode, you’ll be able to:

• Rapidly recognize which hemolytic anemia you’re facing

• Recall ED priorities and life‑saving interventions

• Use the TAG MY SUITCASE mnemonic to never miss a high‑risk patient

Key ED Reminder:

• Stabilize first, follow local protocols, and call for help early.

• When in doubt, think: Recognize → Reverse → Radiology → Refer.

🎧 Listen now and step into the Hemolytic Anemia Mind Palace—where visuals and memory hooks turn complex hematology into rapid recall.