OnlineMedEd: Hematology Oncology - "Thrombocytopenia"

Question 1

TTP stands for ________________.

Answer 1

thrombotic thrombocytopenic purpura

Question 2

TTP arises from deficiency of ______________.

Answer 2

ADAMS-TS 13, a metalloprotease that breaks down vWF

Question 3

Review the signs and symptoms of TTP.

Answer 3

FAT RN 
• Fever
• Anemia
•Thrombocytopenia
• Renal failure 
•Neurologic symptoms

Question 4

Discuss the lab findings of TTP.

Answer 4

• Schistocytes on blood smear
• CBC showing anemia and thrombocytopenia
• Normal DIC panel (i.e., normal PT/PTT, normal D-dimer, and normal fibrinogen)

The DIC panel is normal because the clots are hyaline clots and not fibrin clots, as in DIC.

Question 5

How do you treat TTP?

Answer 5

Exchange transfusion

Never give more platelets because that would just add to the problem.

Question 6

DIC presents in what kinds of patients?

Answer 6

• Sepsis
• Shock
• AML

Question 7

Explain the lab workup of DIC.

Answer 7

• CBC showing low platelets
• Smear showing schistocytes
• PT/PTT elevated due to clotting factor consumption in fibrin clots
• Fibrinogen low due to consumption in fibrin clots
• D-dimer elevated because of fibrin clots

Question 8

How do you treat DIC?

Answer 8

Supportive care (that is, treat the underlying disease)

Question 9

Review the treatment for HIT.

Answer 9

1) Stop the heparin
2) Switch to argatroban (because the person is going to clot from HIT and needed heparin for some reason to begin with)
3) Bridge to warfarin

Question 10

ITP is diagnosed by ________________.

Answer 10

ruling out all other causes of thrombocytopenia

Question 11

ITP is treated with ______________.

Answer 11

steroids, IVIG (hide the platelets from the antibodies), and splenectomy in refractory cases

Rituximab can be used in cases that don’t respond to splenectomy.