Thrombotic Thrombocytopenic Purpura Flashcards
What is TTP?
thrombotic microangiopathy caused by a deficiency of ADAMTS13, leading to widespread microvascular thrombosis.
There will be schistocytes and thrombocytopenia.
How does TPP affect INR and APTT?
No effect as it does not directly impact coagulation cascade
What is the clinical presentation of TTP?
Micro vascular thrombosis causing:
neurological symptoms (e.g., confusion, seizures)
Fever
Microangiopathic anaemia
Low haemoglobin
renal dysfunction with raised creatinine
What is immune thrombocytopenic purpura?
ITP is an autoimmune disorder leading to isolated platelet destruction, causing thrombocytopenia but with normal INR and APTT. It is a type II hypersensitivity reaction whereby the spleen produces antibodies directed against the glycoprotein IIb/IIIa or Ib-V-IX complex
What causes muscle haematoma and haemarthroses?
Haemophilia
What does LMWH increase the risk of?
How does ITP present in children?
Self-limiting disease which occurs following a viral infection
How does ITP present?
Excessive bruising
Prolonged bleeding
Unusually heavy menstrual flow
Spontaneous gum bleeding or epistaxis
How is ITP manamgned?
Watch and wait due to high rate of spontaneous remission
For persistent cases, steroids can be used as an immunosuppressant for 4-7 days
What is used for major blood loss?
Tranexamic acid, antifibrinolytic which impair fibrinolytic dissolution
Blood transfusions
What causes high INR?
Liver failure and decrease in consumption of foods containing vitamin K
Overdose of anticoagulant
Herbal products
Which medications can cause high INR?
Antibiotic
Antigunfl
Amiodarone
What to do for patients on anticoagulants with minor bleeding?
Stop anticoagulants
Administer IV vitamin K
Repeat INR after 24 hours, may need further vitamin K
What to do for patients on anticoagulants with major bleeding?
Stop anticoagulants
Administer IV vitamin K
Administer prothrombin complex (preferred to FFP)
What is given generally for major bleeding?
Prothrombin complex concentrate
What is given as an alternative for prothrombin complex concentrate?
Fresh frozen plasma
What is the target INR for patients on anticoagulation therapy?
2.5 to 3.5
