Bleeding & Thrombosis Flashcards
Initial Labs to get in patients with suspected bleeding d/o
CBC
Platelet count
Peripheral Smear
D-Dimer
von Willebrand disease screen
Platelet function Analyzer
Thrombin Time
PT
PTT
Excessive bleeding does not occur in surgery or trauma patients unless platelet count is lower than what?
75,000
Platelet counts less than what are at high risk for spontaneous life-threatening hemorrhage?
5,000-10,000
What are the three broad mechanisms for developing thrombocytopenia?
Increased Destruction
Decreased Production
Sequestration
When to transfuse platelets:
stable nonbleeding patients?
Bleeding patients?
ICH or NSGY patients?
<10,000
<50,000
<100,000
Normal Dose for Platelets transfusion?
Expected response from platelet transfusion?
Duration of transfused platelets if no consumption is?
1 unit (5-pack or single donor)
increased by 20,000-30,000
3-5d
Contraindications to Platelet Transfusions?
Idiopathic thrombocytopenic purpura (ineffective)
Thrombotic thrombocytopenic purpura
Heparin induced thrombocytopenia
If a patient has rise in platelet count ~1hr after transfusion but it falls substantially 24 hrs later the patient has what going on?
This is seen in patients with what conditions?
Consumption
DIC
Sepsis
severe hemorrhage
drug-mediated immune destruction of platelets
/
If the patient fails to have a significant increase in platelets 1hr after transfusion the patients has what going on?
These patients may have what conditions?
Destruction
Hypersplenism
Autoantibody that eliminates endogenous platelets but also allogenic platelets (as in ITP)
Alloantibodies that react with antigens on transfused platelets
/
Most frequent cause of cytopenias is?
Thrombocytopenia w/n days to weeks following initiation of a new drug is highly suggestive of what?
drug induced thrombocytopenia
Heparin Induced Thrombocytopenia
Antibody development activates platelets following what?
What % of patients develop thrombosis if left untreated?
May develop what? and require what?
Mortality rate in patients with HIT?
Platelets will drop how low in how long?
heparin exposure
~38-76%
gangrenous limbs that require amputation
30%
<100,000 or 50% from baseline w/n 5-14 days
What Score will help calculate probability of HIT?
4T test
What Lab tests can be ordered to diagnose HIT?
LIA test
ELISA test
SRA test
If HIT is suspected what actions should be made?
Stop all heparin immediately
Alternative anticoagulation should be administered
Hematology c/s
What alternative anticoagulation should be used if HIT is suspected?
Direct thrombin inhibitor (Argatroban or Bivalirudin)
DOACs
Clinical Manifestations of ITP
ITP can occur in patients of what sex? and what age?
Most adults with this disease experience what?
Thrombocytopenia and bleeding typically occurs where?
Patients typically experience this as well?
either sex; any age
chronic, recurring disorder
skin mucous membranes
fatigue
ITP patients can experience bleeding where?
epistaxis
gingival bleeding
hematuria
melena
excessive vaginal bleeding
bruising
Physical exam should pay particular attention to signs of mucocutaneous bleeding or hemorrhage w/n what?
the conjunctiva
retina
CNS
ITP Diagnosis includes?
Hx/Physical (Bleeding symptoms, recent infections, underlying conditions)
CBC (Thrombocytopenia, Peripheral Smear remarkable only for decreased # of platelets, some of which may be larger than normal)
Coags
HIV and HCV
Immunologic (Consider ANA, TSH)
Treatment
1st line?
Secondary Treatments?
Corticosteroids
IVIG
Anti-Rho(D)
Thrombopoietin receptor agonists
ITP Thrombopoietin Receptor Agonists?
Romiplostim
Eltombopag
Avatrombopag
