Thrombocytopenia

Question 1

What are hints on a bone marrow biopsy that suggest ITP?

Answer 1

Increased megakaryocytes

Question 2

What is the goal of treatment in ITP?

Answer 2

Normal hemostasis, not a normal platelet count

Question 3

When to treat someone with ITP?

Answer 3

Platelets <30k

Question 4

Upfront management of ITP (2 options)

Answer 4

Steroids
IVIG

Question 5

Second line therapy for ITP (three options)

Answer 5

Splenectomy
Rituximab
TPO-RAs
Fostamatinib

Question 6

Fostamatinib mechanism of action

Answer 6

Syk inhibitor

Question 7

Reasons to treat patients with ITP in pregnancy (3)

Answer 7

Symptomatic
Platelet count 20-30
Prior to procedures

Question 8

First line therapy for ITP in pregnancy (2)

Answer 8

Steroids
IVIG

Question 9

Treatment of refractory ITP in pregnancy (4)

Answer 9

Anti-D Immunoglobulin
Azathioprine
Methylprednisolone + IVIG
Splenectomy in second trimester

Question 10

Inpatient admitted for pancreatitis, put on UFH prophylaxis. On HD5 platelet count dropped from 150 to 60. Diagnosis and treatment?

Answer 10

stop heparin
argatroban

Question 11

What is the difference between typical and rapid onset HIT?

Answer 11

Typical onset between D5-10
Rapid onset Day <1. Always occurs in patients with recent heparin exposure who are re-exposed

Question 12

what is the main concern if you tried to treat someone with HIT with warfarin?

Answer 12

Venous limb gangrene (like warfarin skin necrosis but the location is in limbs)

Question 13

What is the typical feature of spontaneous HIT?

Answer 13

After knee replacement or infection

Question 14

What is the difference in treatment for spontaneous HIT vs traditional HIT?

Answer 14

Give IVIG. High risk of DTI failure

Question 15

What thrombosis location is commonly seen in VITT?

Answer 15

CSVT or splanchnic vein thrombosis

Question 16

Treatment of VITT

Answer 16

Anticoagulate with DOAC or DTI
IVIG x2 days