45: Platelet and Bleeding Disorders - Kanis

Question 1

What do you do with warfarin/coumadin with the following INRs?
INR less than 5
INR 5-9
INR greater than 9
Bleeding

Answer 1

lower or omit dose

omit dose +/- vitamin K 1-2.5 mg PO

omit dose and vit K 5-10 mg PO

omit dose, vit K 10 mg IV +/- FFP

Question 2

Diagnosis of HIT and treatment

Answer 2

diagnose with ELISA for anti PF4/Heparin antibodies

Treatment: discontinue heparin and start another anticoagulant

Question 3

Prolonged PT, PTT, thrombin time and a reduced fibrinogen level =

Answer 3

DIC

because coagulation prtns are depleted

also see elevated fibrin degradation products, D-dimer increased, and schistocytes

Question 4

PT, PTT and fibrinogen are normal

Answer 4

TTP and HUS

because coagulation prtns are not depleted

also see anemia, thrombocytopenia, LDH elevation