Transcript MCQ 2 Which is NOT associated with TTP?

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?
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Thrombotic thrombocytopenia purpura
Immune thrombocytopenic purpura
Heparin induced thrombocytopenia
Cirrhosis
Polycythemia vera
MCQ 2
• Which is NOT associated with TTP?
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Megaloblastic anemia
Fever
Central nervous system signs
Thrombocytopenia
Renal dysfunction
MCQ 3
• Which drug has NOT been implicated as a
possible cause of TTP?
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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?
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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)?
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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?
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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?
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Discontinuation of all heparin
Avoidance of warfarin
Initiation of Argatroban
Initiate aspirin therapy
Key Points
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Consider TTP if the following pentad is
met: fever, renal failure, thrombocytopenia,
CNS involvement, and microangiopathic
hemolytic anemia.
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ITP is more common in females and equally
affects children and adults.
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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