You are a young #medicine resident, you recieve a call from your surgery colleague ๐
The patient posted for surgery has THROMBOCYTOPENIA (TCP) ๐ฒ๐ญ
Here's what you need to know ๐๐ผ
#MedTwitter
1/12
The patient posted for surgery has THROMBOCYTOPENIA (TCP) ๐ฒ๐ญ
Here's what you need to know ๐๐ผ
#MedTwitter
1/12
Does the patient REALLY have TCP ?
TCP is defined as platelet count <150k !!
So, 149k is TCP right ?
Yes, but get a smear to look for platelet clumps, satellitism, large platelets etc.
The smear tells you a lot ๐ช๐ผ
2/12
TCP is defined as platelet count <150k !!
So, 149k is TCP right ?
Yes, but get a smear to look for platelet clumps, satellitism, large platelets etc.
The smear tells you a lot ๐ช๐ผ
2/12
Let's enlist what one commonly finds on a BLOOD FILM !!
Platelet clumps = pseudoTCP d/t EDTA
Large platelets = platelet destruction
Schistocytes = TTP/ DIC
Blasts/ atypical cells = leukemia
3/12
Platelet clumps = pseudoTCP d/t EDTA
Large platelets = platelet destruction
Schistocytes = TTP/ DIC
Blasts/ atypical cells = leukemia
3/12
It always helps to know the TREND, the rapidity of the fall. If it's an acute fall, work up rapidly. Could be drug induced, cancer, sepsis, TTP etc.
So, always ask for past reports !!
Remember this ๐๐ผ
4/12
So, always ask for past reports !!
Remember this ๐๐ผ
4/12
Next question: Is the patient SICK ??
If yes, think sepsis, DIC, malignancy, drug induced, TTP etc.
About 40% of pts in ICU have TCP and the DDx is huge.
The blood film will come to the rescue, again !!
5/12
If yes, think sepsis, DIC, malignancy, drug induced, TTP etc.
About 40% of pts in ICU have TCP and the DDx is huge.
The blood film will come to the rescue, again !!
5/12
Always take a detailed DRUG HISTORY, including h/o alternate medicationโ
Heparin flushes for those w/ central lines- often overlooked.
HIT is RARE, calculate 4T score. If โฅ6, the probability is high and needs confirmation. STOP all heparin ASAP, screen for thrombosis!
6/12
Heparin flushes for those w/ central lines- often overlooked.
HIT is RARE, calculate 4T score. If โฅ6, the probability is high and needs confirmation. STOP all heparin ASAP, screen for thrombosis!
6/12
What we've learnt till now:
๐ธ<150k is TCP
๐ธBLood smear is important
๐ธRapidity of fall is important
๐ธDrugs are common culprits
๐ธHIT is rare, often over diagnosed
7/12
๐ธ<150k is TCP
๐ธBLood smear is important
๐ธRapidity of fall is important
๐ธDrugs are common culprits
๐ธHIT is rare, often over diagnosed
7/12
So what next, EXAMINATION !!
Look for bleeding manifestations
Splenomegaly
Fever, signs of infection
Pallor etc
Remember, ITP is a diagnosis of exclusion, expect a normal physical โ
8/12
Look for bleeding manifestations
Splenomegaly
Fever, signs of infection
Pallor etc
Remember, ITP is a diagnosis of exclusion, expect a normal physical โ
8/12
What if the patient has TCP but also THROMBOSIS ๐ฒ
What's the ddx here ?
๐ธHIT
๐ธDIC
๐ธTTP
๐ธAPLA
DIC is the commonest of these. Check coagulation profile.
DIC: PT/aPTTโคด๏ธ
TTP: PT/aPTT is normal
PLASMIC score for TTP, I've tweeted about it many a times before.
9/12
What's the ddx here ?
๐ธHIT
๐ธDIC
๐ธTTP
๐ธAPLA
DIC is the commonest of these. Check coagulation profile.
DIC: PT/aPTTโคด๏ธ
TTP: PT/aPTT is normal
PLASMIC score for TTP, I've tweeted about it many a times before.
9/12
DDx of TCP in pregnancy:
๐ธGestational TCP
๐ธITP
๐ธHELLP
๐ธPre-eclampsia
๐ธTTP
๐ธDIC and the rest !!
Never think gestational TCP if platelets <50k !
#MedTwitter
11/12
๐ธGestational TCP
๐ธITP
๐ธHELLP
๐ธPre-eclampsia
๐ธTTP
๐ธDIC and the rest !!
Never think gestational TCP if platelets <50k !
#MedTwitter
11/12
Let's summarise:
๐ธExclude pseudoTCP (Blood film)
๐ธDrug history โ
๐ธClinical context (sick vs not sick)
๐ธDegree & rapidity of developing TCP
๐ธSigns of bleeding/Thrombosis
If you read the whole thread ๐๐ผ
#MedTwitter
12/12
๐ธExclude pseudoTCP (Blood film)
๐ธDrug history โ
๐ธClinical context (sick vs not sick)
๐ธDegree & rapidity of developing TCP
๐ธSigns of bleeding/Thrombosis
If you read the whole thread ๐๐ผ
#MedTwitter
12/12
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