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Tuesday Conference Approach to Thrombocytopenia

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Thrombotic thrombocytopenia purpura Immune thrombocytopenic purpura Heparin induced thrombocytopenia Cirrhosis Polycythemia vera MCQ 2 Which is NOT associated with TTP? – PowerPoint PPT presentation

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Title: Tuesday Conference Approach to Thrombocytopenia


1
Tuesday ConferenceApproach to Thrombocytopenia
  • Selim Krim, MD
  • Assistant Professor
  • TTUHSC

2
Case 1
  • A 35-year-old woman is hospitalized for recurrent
    thrombophlebitis and a pulmonary embolus and is
    started on heparin.
  • Two weeks earlier, she had completed a 6-month
    anticoagulation therapeutic regimen. A CBC on day
    5 of her hospitalization shows a platelet count
    of 70,000/mm3.

3
MCQ 1
  • Which of the following is NOT associated with
    thrombocytopenia?
  • Thrombotic thrombocytopenia purpura
  • Immune thrombocytopenic purpura
  • Heparin induced thrombocytopenia
  • Cirrhosis
  • Polycythemia vera

4
MCQ 2
  • Which is NOT associated with TTP?
  • Megaloblastic anemia
  • Fever
  • Central nervous system signs
  • Thrombocytopenia
  • Renal dysfunction

5
MCQ 3
  • Which drug has NOT been implicated as a possible
    cause of TTP?
  • Ticlopidine
  • Cyclosporine
  • Tacrolimus
  • Quinine
  • Fluorouracil

6
MCQ 4
  • Which is INCORRECT about ITP?
  • It is as common in children as it is in adults
  • It occurs more in adults men than in adult women
  • It can be secondary to other diseases
  • A bone marrow is not required for all patients
  • Evans syndrome describes a combination of
    hemolytic anemia with ITP

7
MCQ 5
  • Which treatment is NOT indicated for ITP?
  • Corticosteroids
  • Intravenous immunoglobulin
  • Plasmapheresis
  • Anti-D immune globulin
  • Splenectomy

8
MCQ 6
  • Which of the following patient populations has
    the highest risk of HIT (assume all are receiving
    the same dose of heparin)?
  • After general surgery
  • Hospitalized pediatric patients
  • After orthopedic surgery
  • Hospitalized general internal medicine patients
  • Hospitalized obstetric patients

9
MCQ 7
  • Which is least suggestive of HIT?
  • Platelet countlt20,000/ mm3
  • Venous thrombosis
  • Arterial thrombosis
  • Low molecular-weight heparin use within the
    previous week
  • Abnormal serotonin release assay

10
MCQ 8
  • How should one monitor for HIT in patients
    receiving heparin after undergoing orthopedic
    surgery?
  • Daily platelet counts
  • Platelet counts every other day from day 4 to 14
    of heparin treatment
  • Platelet counts at days 7 and 14 of heparin
    treatment
  • Antibody levels for all patients at day 14 of
    therapy
  • Never unless thrombosis is suspected

11
MCQ 9
  • Which is NOT considered important in the initial
    treatment of HIT type II?
  • Discontinuation of all heparin
  • Avoidance of warfarin
  • Initiation of Argatroban
  • Initiate aspirin therapy

12
Key Points
  • Consider TTP if the following pentad is met
    fever, renal failure, thrombocytopenia, CNS
    involvement, and microangiopathic hemolytic
    anemia.
  • ITP is more common in females and equally affects
    children and adults.
  • HIT is most often encountered in orthopedic
    patients taking heparin.

13
Key Points
  • HIT can cause a coagulopathy with venous or
    arterial thrombi.
  • If HIT occurs, all heparin products should be
    discontinued and a non-heparin, non-warfarin
    anticoagulant should be initiated.
  • In HIT alternative anticoagulation should
    continue for at least 2 weeks after heparin has
    been discontinued.

14
  • Thank You
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