APPROACH TO THROMBOCYTOPENIA

Question 1

MANAGEMENT

Answer 1

LIFE-THREATENING BLEED
Tranfusion
C/I TTP

GENERAL INVESTIGATIONS
CBC (Platelet Count) and Blood Film
Retic Count
PT, PTT, INR, D-Dimer
LDH
Haptoglobin
Liver Function

TARGETED INVESTIGATIONS
Vitamin B12
Viral Screen (HBV / HCV / HIV / EBV)
Autoimmune Screen (if applicable)
ADAM13 Assay (if suspected TTP)
HIT Assay if intermediate – high 4T score
Abdo Ultrasound
BM Biopsy

DIC:
Elevated D-Dimer
Decreased Fibrinogen
Prolonged Coagulation Studies

Aggressively treat the underlying cause
Transfuse platelets to 50 × 109/L AND
FFP to maintain a fibrinogen level of 150 mg/dL (1.5 g/L)

TTP:
Normal Coagulation Studies
Elevated LDH
Decreased Haptoglobin

Administer 1.5 mg/kg/d methylprednisolone
apheresis line
consult Hematology/transfer for plasma exchange.

Question 2

DOCUMENTATION

Answer 2

Cardiac nature patient just literally shocked but the last was handed and then I have not seen anybody since yeah thank
CLINICAL FEATURES
Petechial
Purpura
Easy bruising
Mucosal Bleeding (Epistaxis, Heavy Vaginal Bleed, GI / GU bleeding)

Question 3

CRITICAL DDx

Answer 3

INCREASED DESTRUCTION
TTP
Anemia
Normal Coagulation Studies
Elevated LDH
Decreased Haptoglobin
Renal Dysfunction

HUS
Anemia
Normal Coagulation Studies
Renal Dysfunction

DIC
Anemia
Elevated D-Dimer
Decreased Fibrinogen
Prolonged Coagulation Studies

ITP
NO Anemia

HIT
Heparin use within last 2 weeks

Question 4

NON CRITICAL DDX

Answer 4

Decreased Production:
Aplastic Anemia
MDS
Leukemia
Myelosuppressive Drugs (EtOH, Chemo, Rads)
DM Infiltrate
B12 / Folate Deficiency
HIV / HBV / HCV / EBV

Sequestration:
Hypersplenism