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Flashcards in Heme - ITP & TTP/HUS Deck (22):
0

Physical findings suggestive of thrombocytopenia/abnormal platelet function versus coagulation abnormality?

Mucosal bleeding, epistaxis/gums, petechia, purpura

versus

hemarthrosis, hematomas, Retroperitoneal bleeding

1

Causes of impaired platelet production?

Concomitant finding?

1. Myelofibrosis
2. Bone marrow suppression due to drugs, radiation
3. Malignancy

Also will see a decrease in RBCs and WBCs

2

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

3

Test for ITP?

Direct Coombs test

4

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

5

Causes of drug induced thrombocytopenia?

H2-blockers, quinine, sulfonamides

6

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)

7

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

Platelet transfusion

8

PT/PTT and Coombs' test results in HUS versus TTP?

All normal

9

Treatment for severe HUS/TTP? If delay in getting patient to plasmapheresis, use?

Do not give these patients?

Plasmapheresis

Infuse FFP

Platelets

10

Patient presents with isolated thrombocytopenia and normal sized spleen – most likely diagnosis?

ITP

11

Patient presents with episodes of bleeding and a platelet count of 17,000. PE normal - treatment??

ITP

Prednisone

12

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

13

Before splenectomy, give all patients?

Meningococcus, pneumococcus, H. flu

14

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

Aspirin

PTT

15

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

16

Diagnostic tests for Von Willebrand disease?

#Ristocetin cofactor assay/von Willebrand factor activity test
#Von Willebrand factor level
#Factor 8 activity

17

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

18

factor 11 deficiency - labs? Presentation? Treatment?

Elevated PTT that is normalized after mixing study

Increased bleeding after trauma/surgery

Fresh frozen plasma

19

Patient with elevated PTT but no increased risk of bleeding?

Factor 12 deficiency

20

Lab findings in DIC?

#Elevation in PT and PTT
#Low platelet count
#Elevated D dimer and fibrin split products
#Decreased fibrinogen

Replace platelets and clotting factors (FFP)

21

Best initial test for APLS?

Mixing study – PTT will remain elevated

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