IMT - Specific

Question 1

Platelet counts are usually < ______ in ITP

Answer 1

10,000

Question 2

Anemia if present should be Regenerative or NR?

Answer 2

Regenerative

Can take several days for regeneration to be evident after acute bleed

Question 3

Rest of BW is usually unremarkable in 1º ITP. T/F

Answer 3

T

Question 4

Clotting times are abnormal in ITP. T/F

Answer 4

False

they are NORMAL

Question 5

PT,PTT are increased in ITP. T/F

Answer 5

False

Clotting times are normal

Question 6

If you suspect ITP but the platelet count is >30,000, then what do you expect as differentials?
-
-
-
-

Answer 6

• Rat poison
• Rickettsial disease
• Cancer
• 2º to sepsis

Question 7

Main DD for ITP?

Answer 7

• Rat poison
• Cancer
• Evans syndrome
• Severe DIC

Question 8

In Evans syndrome, you expect concurrent IMHA with _____ & other evidence of hemolysis

Answer 8

SPHEROCYTES

Question 9

What do you discern from a Cavalier King Charles Spaniel with platelet count at 30,000

Answer 9

They have Macro-thrombocytopenia

Platelets can be as low as 30,000 and be normal

Question 10

No juglar sticks and no cystos in cases of ITP. T/F

Answer 10

T

Question 11

Diagnostics in cases of ITP?

Answer 11

-CBC(with pathologist review)/Chem/ UA +/- UC
-Clotting panel
-Tick PCR or 4DX if low risk
+/- SAT if anemic to r/o evan’s syndrome
+/- CXR,AUS
+/- BM if not typical ITP

Question 12

When to consider BM sampling?

Answer 12

If not typical ITP

Question 13

Which test to do to r/o Evan’s Syndrome if ITP suspected pet is anemic?

Answer 13

Saline Agglutination Test

SAT

Question 14

Why consider CXR,AUS?

Answer 14

To r/o underlying cancer

Especially important if older

Question 15

Rx for Evan’s Syndrome ?

Answer 15

-Corticosteroids
-Doxycyline
-Gastroprotectants +/- anti-emetics
-Blood tranfusion products
+/- vincristine and aminocaproic acid

Question 16

Regarding corticosteroids as Rx for ITP?

Answer 16

Initially, Dexamethasone 0.2 mg/kg IV once if not eating or vomiting and then Prednisone 1 mg/kg PO BID

Question 17

Regarding Doxycycline as Rx for ITP?

Answer 17

5 mg/kg PO BID pending tick PCR or 14 d if tick PCR not done

Question 18

Which gastroprotectants to use?

Answer 18

Omeprazole + Sucralfate

Separate carafate from other drugs by atleast 1 hr

Question 19

Which blood tranfusion product to choose?

Answer 19

• if active bleeding → FRESH whole blood (Fresh blood preferred over stored)
• if not currently bleeding but anemia → pRBC

Question 20

When to consider Vincristine in cases of ITP?

Answer 20

• use once
• if not vomiting and WBC is normal
• Wear gloves while using

0. 02 mg/kg IV
   * *use IV catheter <24 hr old

Question 21

What other medications to consider if pet not responding?

Answer 21

Aza-thio-prine
Myco-phenolate
Cyclosporine