Flashcards in Heme - ITP & TTP/HUS Deck (22):
Physical findings suggestive of thrombocytopenia/abnormal platelet function versus coagulation abnormality?
Mucosal bleeding, epistaxis/gums, petechia, purpura
hemarthrosis, hematomas, Retroperitoneal bleeding
Causes of impaired platelet production?
2. Bone marrow suppression due to drugs, radiation
Also will see a decrease in RBCs and WBCs
ITP affects what age groups? Difference in course of disease?
Most common children following up URI. Results spontaneously within 3 to 6 months.
Also affects women ages 20 to 40. Persist for months to years with uncommon spontaneous remission
Test for ITP?
Direct Coombs test
Treatment of ITP and adults?
1 to 2 mg/kilograms of prednisone
Add IVIg if platelet counts are <10,000
If patients do not respond to steroids, can perform splenectomy
Causes of drug induced thrombocytopenia?
H2-blockers, quinine, sulfonamides
Types of heparin-induced thrombocytopenia?
HIT-1: Not immune mediated, onset <48 hours, caused Platelet clumping
HIT-2: caused by platelet activating antibodies, occurs after three days (Unless patient has been sensitized prior to this)
Consequence of HIT? Diagnosed by? Treatment? No not treat with?
Thrombosis (not bleeding)
ELISA for PF4 OR 5HT release assay
Direct thrombin inhibitor – argatroban, lepirudin THEN warfarin
PT/PTT and Coombs' test results in HUS versus TTP?
Treatment for severe HUS/TTP? If delay in getting patient to plasmapheresis, use?
Do not give these patients?
Patient presents with isolated thrombocytopenia and normal sized spleen – most likely diagnosis?
Patient presents with episodes of bleeding and a platelet count of 17,000. PE normal - treatment??
Treatment protocol for ITP?
#No bleeding and platelets over 30,000 – no treatment
#Mild bleeding platelets under 30,000 – glucocorticoids
#Severe bleeding platelets under 10,000 – IV IG, anti-Rho
#Recurrent bleeding episodes, and steroid dependence – splenectomy
#Splenectomy not effective – Romiplostim (synthetic thrombopoetin) or steroid alternates
Before splenectomy, give all patients?
Meningococcus, pneumococcus, H. flu
Patient presents with platelet bleeding (epistaxes, gingival, gums) with a normal platelet count – suspected diagnosis? Will likely worsen if patient takes? This lab may be elevated?
Von Willebrand disease
Patient with suspected von Willebrand disease – best initial therapy? If no response?
DDAVP (Releases said endothelial stores von Willebrand factor)
If no response, use factor VIII replacement
Diagnostic tests for Von Willebrand disease?
#Ristocetin cofactor assay/von Willebrand factor activity test
#Von Willebrand factor level
#Factor 8 activity
Coagulation studies in hemophilia? Most accurate test? Treatment?
Elevated PTT, corrects with mixing study
Specific assay for factor 8 or 9
#Mild cases – DDAVP
#Severe bleeding – factor replacement
factor 11 deficiency - labs? Presentation? Treatment?
Elevated PTT that is normalized after mixing study
Increased bleeding after trauma/surgery
Fresh frozen plasma
Patient with elevated PTT but no increased risk of bleeding?
Factor 12 deficiency
Lab findings in DIC?
#Elevation in PT and PTT
#Low platelet count
#Elevated D dimer and fibrin split products
Replace platelets and clotting factors (FFP)