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Download MCQ 2 Which is NOT associated with TTP?
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Tuesday Conference Approach to Thrombocytopenia Selim Krim, MD Assistant Professor TTUHSC Case 1 • A 35-year-old woman is hospitalized for recurrent thrombophlebitis and a pulmonary embolus and is started on heparin. • Two weeks earlier, she had completed a 6month anticoagulation therapeutic regimen. A CBC on day 5 of her hospitalization shows a platelet count of 70,000/mm3. MCQ 1 • Which of the following is NOT associated with thrombocytopenia? • • • • • Thrombotic thrombocytopenia purpura Immune thrombocytopenic purpura Heparin induced thrombocytopenia Cirrhosis Polycythemia vera MCQ 2 • Which is NOT associated with TTP? • • • • • Megaloblastic anemia Fever Central nervous system signs Thrombocytopenia Renal dysfunction MCQ 3 • Which drug has NOT been implicated as a possible cause of TTP? • • • • • Ticlopidine Cyclosporine Tacrolimus Quinine Fluorouracil MCQ 4 • Which is INCORRECT about ITP? • It is as common in children as it is in adults • It occurs more in adults men than in adult women • It can be secondary to other diseases • A bone marrow is not required for all patients • Evans syndrome describes a combination of hemolytic anemia with ITP MCQ 5 • Which treatment is NOT indicated for ITP? • • • • • Corticosteroids Intravenous immunoglobulin Plasmapheresis Anti-D immune globulin Splenectomy MCQ 6 • Which of the following patient populations has the highest risk of HIT (assume all are receiving the same dose of heparin)? • • • • After general surgery Hospitalized pediatric patients After orthopedic surgery Hospitalized general internal medicine patients • Hospitalized obstetric patients MCQ 7 • Which is least suggestive of HIT? • • • • Platelet count<20,000/ mm3 Venous thrombosis Arterial thrombosis Low molecular-weight heparin use within the previous week • Abnormal serotonin release assay MCQ 8 • How should one monitor for HIT in patients receiving heparin after undergoing orthopedic surgery? • Daily platelet counts • Platelet counts every other day from day 4 to 14 of heparin treatment • Platelet counts at days 7 and 14 of heparin treatment • Antibody levels for all patients at day 14 of therapy • Never unless thrombosis is suspected MCQ 9 • Which is NOT considered important in the initial treatment of HIT type II? • • • • Discontinuation of all heparin Avoidance of warfarin Initiation of Argatroban Initiate aspirin therapy Key Points • Consider TTP if the following pentad is met: fever, renal failure, thrombocytopenia, CNS involvement, and microangiopathic hemolytic anemia. • ITP is more common in females and equally affects children and adults. • HIT is most often encountered in orthopedic patients taking heparin. Key Points • HIT can cause a coagulopathy with venous or arterial thrombi. • If HIT occurs, all heparin products should be discontinued and a non-heparin, nonwarfarin anticoagulant should be initiated. • In HIT alternative anticoagulation should continue for at least 2 weeks after heparin has been discontinued. Thank You
