10/5/15 Morning Report DIC versus TTP

– Clinical presentation of platelet disorders vs factor disorder. Epistaxis and petechiae are more suggestive of platelet disorders. Factor deficiency is usually associated with larger bleeds such as hemoarthrosis.
– Palpable purpura….think Leukocytoclastic Vasculitis.
– Thrombocytopenia Framework: Decreased production, increased breakdown, sequestration, dilutional
– Treatment for APL is ATRA. Remember to consider ATRA differentiation syndrome which can present with pleural effusions, edema, shortness of breath, and fever. Treat ATRA differentiation syndrome with Prednisone.
– Causes of MAHA: DIC, TTP/HUS, malignant hypertension, mechanical valves, HELLP/Pre-eclampsia, Scleroderma renal crisis
– It is important to distinguish between TTP and DIC because the treatment is different. DIC – treat the underlying cause and supportive care. TTP – treat with Plasmapharesis.
Thrombocytopenia x x
Fibrin Degradation Products x
Elevated D-Dimer x
Low Fibrinogen x
Elevated LDH x x
Elevated PT and PTT x
MAHA/Schistocytes x x
Leukopenia x

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