Idopathic thrombocytopenia purport/DIC Flashcards
ITP what is it?
idiopathic thrombocytopenia purpura
thrombocytopenia resulting from autoimmune destruction of platelets with or without suppression of thrombopoiesis
Labs and diagnostics of ITP
bone marrow analysis
-low platelet count with other causes of thrombocytopenia ruled out: there may be a history of easy bruising or bleeding
management of ITP
may not be necessary until platelet count is < 20,000
- high dose corticosteroids may help to elevate the platelet count within 2-3 days
- gamma globulin is preferred to steroids in HIV related ITP
thrombocytopenic precautions
avoid constipation
no flossing
no shaving
hold pressure for 5 min for cuts etc
Heparin-induced thrombocytopenia (HIT)
argatroban
lepirudin
What is DIC
coagulation disorder resulting from intravascular activation of both the coagulation and fibrinolytic systems (thrombin and plasmin are activated) causing simultaneous thrombosis and hemorrhage. Mortality rate is 50-85%
associated conditions with DIC
- malignant neoplasms
- infections/sepsis
- liver dz
- ext burns
- shock
- obstetrical complications
- acute leukemia
what produces fibrin clots in our microcirculation
thrombin causes conversion of fibrinogen to fibrin producing fibrin clots
what are coagulation factors?
fibrinogen, prothrombin, platelets, factors 5 and 8. They are reduced with production of fibrin clots because fibrinogen converted to fibrin
what does circulating thrombin do?
activates fibrinolytic system which lyses fibrin clots into fibrin degradation products (FDPs)
How does hemorrhage result?
from the anticoagulant activity of FDPs and the depletion of coagulation factors
labs and diagnostics of DIC
-thrombocytopenia (platelets < 150,000)
-hypofibrinogenemia (fibrinogen < 170)
-decreased RBCs
-increased fibrin degradation products > 45
prolonged Pt > 19 sec
prolonged PTT > 42 sec
D dimer increased
management of DIC
platelet transfusions (for thrombocytopenia), FFP (to replace clotting factors), and cryoprecipitate (to maintain fibrinogen levels) are given if bleeding is severe
overall therapy is aimed at cessation of bleeding, increasing plasma fibrinogen and platelet count and decreasing FDPs
