ITP , TTP vs. HUS vs. DIC

Question 1

Autoantibodies against GPIIb/IIIa receptors

Answer 1

Immune Thrombocytopenia (ITP)

Question 2

Secondary (Associated Conditions) of immune thrombocytopenia

Answer 2

o Autoimmune: Lupus (SLE)
o Hematologic: CLL
o Infectious: HIV, Hepatitis C, CMV, Varicella

Question 3

Treatment of Immune thrombocytopenia
In children:

Answer 3

Often self-resolving, monitor unless severe

Question 4

Treatment of Immune thrombocytopenia
Adult : Often chronic, requires treatment if platelets <30,000/µL

Answer 4

o First-line: Corticosteroids
o Second-line: IVIG
o Refractory cases: Splenectomy
o Platelet transfusion only for severe bleeding

Question 5

Deficiency of ADAMTS13 (vWF-cleaving protease)

Answer 5

Thrombotic Thrombocytopenic Purpura
(TTP)

Question 6

Accumulation of large vWF multimers → platelet aggregation

Answer 6

Thrombotic Thrombocytopenic Purpura
(TTP)

Question 7

Clinical Features (Pentad) of TTP

Answer 7

1. Thrombocytopenia (petechiae, purpura)
2. Microangiopathic Hemolytic Anemia (MAHA) (schistocytes, ↑ LDH, ↓
   haptoglobin)
3. Neurologic symptoms (confusion, seizures, stroke)
4. Fever
5. Renal dysfunction (mild)

Question 8

Diagnosis of TTP

Answer 8

 CBC + Peripheral Smear: Schistocytes
 ADAMTS13 Activity: Severe deficiency (<10%) (Not required before starting
treatment)
 Normal PT/PTT (Unlike DIC)

Question 9

Treatment of TTI

Answer 9

 Plasma Exchange (PEX) → Lifesaving
 Glucocorticoids
 Platelet transfusion is contraindicated (worsens thrombosis)

Question 10

Platelet-rich thrombi in small vessels

Answer 10

TTP

Question 11

Platelet-rich thrombi in renal vasculature

Answer 11

Hemolytic Uremic Syndrome (HUS)

Question 12

Shiga-like toxin from E. coli O157:H7 → endothelial damage

Answer 12

HUS

Question 13

Clinical Features (Triad) of HUS

Answer 13

1. Thrombocytopenia
2. MAHA (schistocytes)
3. Acute kidney injury (↑ creatinine)

Question 14

Diagnosis of HUS

Answer 14

 CBC + Peripheral Smear: Schistocytes
 Kidney Function: ↑ Creatinine, ↑ BUN
 Stool culture for E. coli O157:H7

Question 15

Treatment of HUS

Answer 15

 Supportive care (fluids, dialysis if needed)
 No plasma exchange (unlike TTP)

Question 16

Uncontrolled clotting activation → microthrombi + bleeding

Answer 16

DIC

Question 17

Consumption of platelets & coagulation factors

Answer 17

DIC

Question 18

Common Causes Of DIC

Answer 18

 Sepsis (bacterial endotoxins)
 Obstetric emergencies (amniotic fluid embolism)
 Malignancy (APL, adenocarcinomas)

Question 19

Clinical Features of DIC

Answer 19

 Thrombocytopenia + MAHA (schistocytes)
 Diffuse bleeding (IV sites, mucosa)
 Organ dysfunction (kidney failure, ARDS)

Question 20

Diagnosis of DIC

Answer 20

 ↑ PT, ↑ PTT, ↑ INR
 ↑ D-dimer (fibrin degradation product)
 ↓ Fibrinogen
 Peripheral smear: Schistocytes

Question 21

Treatment of DIC

Answer 21

 Treat underlying cause
 Supportive care (blood, platelet transfusions)
 Fresh frozen plasma (clotting factor replacement)