Heme

Question 1

Thrombotic Thrombocytopenic Purpura 
Path:
Pt:
Dx:
Tx:

Answer 1

Path: Hyaline clots, Adam TS-13

Pt: FAT-RN (Don’t have to be an RN to be FAT
Fever
Anemia (microangiopathic hemolytic anemia)
Thrombocytopenia
Renal failure
Neuro sxs

Dx: 
CBC: dec plt
Smear: schistocytes
PT/PTT: normal
Fibrinogen: normal
D-Dimer: Normal

Tx: exchange transfusion; NEVER give plts

Question 2

Idiopathic Thrombocytopenic Purpura (ITP)
Path:
Pt:
Dx:
Tx:

Answer 2

Path: antibody to plt

Pt: female with autoimmune disorder; dec plt

Dx: Diagnosis of exclusion

Tx:
steroids
IVIG
splenectomy
rituximab

Question 3

Hemolytic uremic syndrome (HUS) 
Path:
Pt:
Dx:
Tx:

Answer 3

Path:
Plt activation by exotoxins (shigella toxin, shiva-like toxin in E coli 0157:H7) -> thrombocytopenia
Toxins damage kidney-> uremia and HTN

Pt:
Children with recent gastroenteritis causes by: enterohemorrhagic E coli 0157:H7, Shigella or Salmonella
Triad: thrombocytopenia, microangiopathic hemolytic anemia, kidney failure

Dx:
Increased BUN/Cr
Thrombocytopenia with normal PT/PTT
Hemolytic anemia: peripheral smear schistocytes/ inc reticulocytes; inc LDH; inc direct bilirubin; splenomegaly
Similar to TTP but lacks fever and neurologic sx

Tx:
Observation: IVF
Plasmapheresis
Abx may worsen the condition!

Question 4

Disseminated intravascular coagulation (DIC)
Path:
Pt:
Dx:
Tx:

Answer 4

Path: Pathologic activation of coagulation system-> widespread microthrombi-> severe thrombocytopenia: diffuse bleeding
Infectious (gram negative sepsis, endotoxins); Malignancies; Obstetric; Massive tissue injury (burns); RMSF

Pt:
Widespread hemorrhage
Thrombosis

Dx:
CBC: dec plt
Smear: schistocytes
PT/PTT: inc
Fibrinogen: dec
D-dimer: inc 

Tx:
Supportive
Tx underlying disease

Question 5

Heparin induced thrombocytopenia
Path:
Pt:
Dx:
Tx:

Answer 5

Path: Ab to plts

Pt:
Heparin products within last 7-14 days
Low plts

Dx: HIT antibody +

Tx:
Stop heparin
Start argatroban and bridge to warfarin