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Tuesday Conference Approach to Thrombocytopenia

Tuesday Conference Approach to Thrombocytopenia. Selim Krim, MD Assistant Professor TTUHSC. Case 1. A 35-year-old woman is hospitalized for recurrent thrombophlebitis and a pulmonary embolus and is started on heparin.

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Tuesday Conference Approach to Thrombocytopenia

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  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 count<20,000/ 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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