Who am I?
An asymptomatic drop in platelet count, usually 1-4 days after receiving heparin.
What is Nonimmune Heparin-associated thrombocytopenia (HIT I)?
These particular tests should be performed when suspecting ITP. (Hint: there is a whole list of many things to order, what would be the top 3)
What are a peripheral blood smear, HIV and Hepatitis C virus infection testing?
After urgent plasma exchange in TTP, these two additional treatments can and should be given.
What is corticosteroids and Rituximab?
Antigen assay to detect the presence of anti-PF4 antibodies.
What should be your initial test if HIT is suspected?
LMWH is NOT indicated for the treatment of this disorder.
What is HIT?
A patient complains of weakness, fatigue, confusion, possibly even seizures, abdominal pain, n/v, diarrhea, and arrhythmias are noted in this condition.
What is TTP?
-Neurological symptoms are more common in TTP and less likely in HUS.
Defined as platelets count <100,000/mm3 once all other causes have been ruled out.
What is ITP?
Currently approved for treatment of HITT (Type 2) or patients undergoing PCI when heparin is contraindicated.
What is Argatroban?
Posttraumatic bleeding, bruising tendency, epistaxis, menorrhagia and gingival bleeding are common in this disorder.
What is ITP?
-usually by exclusion
Quinine, cyclosporine, tacrolimus or chemotherapy of mitomycin C or gemcitabine can be associated with this type of thrombocytopenia.
What is Acquired TTP?
-Females
-black ethnicity
-use of desmopressin
Pregnancy
Accelerated platelet uptake and destruction by reticuloendothelial phagocytes from action of this autoantibody against platelet membrane Glycoprotein IIb/IIIa.
What is IgG autoantibodies?
Anemia, thrombocytopenia, with schistocytes on smear, and a positive stool culture or shiga toxin.
What are the common lab findings for HUS?
You need this to be given urgently in a patient with neurological findings, anemia, thrombocytopenia, schistocytes on smear with a low ADAMTS13 activity.
What is urgent plasma exchange?
-TTP
-Untreated TTP is almost always fatal!
-If suspected treatment should begin before confirmatory ADAMSTS13 testing is complete.
5 year old child presents with abdominal pain, bloody diarrhea, fever, seizures and lethargy. You would expect them to be positive for this bacteria.
What is E. coli H7:0157?
-HUS is the most common cause of renal failure in children.
Discontinue other anticoagulants and continue this treatment only after INR is therapeutic (2-3) for at least 5 days.
What is warfarin therapy?
Often asymptomatic, found incidentally on CBC, and is more common in females and when exposure to NSAIDS have been associated with bleeding.
What is ITP?
This has a normal coagulation profile with a negative direct antiglobulin test, evidence of hemolysis, and fragmented RBCs in the shape of helmet cells.
What is TTP?
The goal of ITP treatment is to treat or prevent significant bleeding, not to normalize the platelet count, by giving this agent and what dosage, including routes, first!
-Dexamethasone 40 mg po or IV once daily X 4 days, no taper
-Methylprednisone Ig IV once daily X 3 days, no taper
-Prenisone 1mg/kg oral once daily 1-2 weeks with gradual taper over 6 weeks.
Serotonin release assay (SRA)
What is the gold standard test due to high specificity and high sensitivity for HIT?
Appropriate antithrombotic therapies should not be withheld from patients with platelet counts of this number.
What is platelet count >50,000?
Loose strands of platelets and fibrin are deposited in multiple small vessels and damage passing platelets and RBCs causing significant thrombocytopenia and anemia.
What is TTP or HUS?
Thrombocytopenia often <100,000 but usually >20,000 with a high risk of thrombosis and mortality.
What is HITT (HIT II)?
Supportive (children), platelets (only for severe bleeding or extremely low platelet count), Corticosteroids, IVIG or anti-D immunoglobulin, and/or splenectomy.
What is the management of ITP?
This enzyme is a plasma protease that cleaves vonWillebrand factor into smaller sizes and found in inherited TTP.
Can only be given if bleeding or during an invasive procedure with a high risk of bleeding due to an increase in thrombosis.
What are platelet transfusions?