MS STUDY GUIDE WEEK 2 AND 3 CORRECT Q AND A LATEST: 2022
GRADED A
I. Week 2 – CAD, EKG, HF, Thrombocytopenia, Stable Angina, Atrial Rhythms
A. Thrombocytopenia – reduction of platelets below normal
1. Commonly caused by herbs or drugs that cause accelerated PT destruction via drug-dependent
antibodies which attack platelets when bacteria/virus attaches onto PT surface
2. S/S
a. Bleeding: cutaneous (petechiae, purpura, ecchymoses) OR mucosal (epistaxis,
gingival bleeding, large bullous hemorrhages)
b. Prolonged bleeding or signs of internal bleeding (weakness, fainting, dizziness, tachycardia,
abdominal pain, hypotension)
3. Immune Thombocytopenic Purpura/Idiopathic Thrombocytopenic Purpura (ITP) – most
common; abnormal destruction of circulating PTs
a. PTs are covered with antibodies which, once reaching the spleen, are recognized as foreign
and destroyed by
macrophages
b. Can be caused by infections (H. pylori, viral infections, etc)
c. PT’s survival is shortened (normal: 8-10 days)
d. Interventions
1) (Only intervene if pt is symptomatic OR PT is below 30,000/µL)
2) Avoid aspirin and other meds that affect coagulation
e. Treatments:
1) Meds:
a) Corticosteroids (methylprednisolone) – suppresses antibody
formation and reduces capillary leakage
b) IV Immunoglobulin (IVIG), anti-D, WinRho – competes with anti-PT
antibodies for macrophage
receptors
i. Use IF pt is unresponsive to corticosteroids, splenectomy, or cannot
have splenectomy
c) Rituximab – lyse activated B cells reducing immune recognition of PTs
d) Romiplostin (Nplate), eltrombopag (Promacta) – for pts w/ chronic ITP
w/ insufficient response to meds or contraindication to splenectomy
,MS STUDY GUIDE WEEK 2 AND 3 CORRECT Q AND A LATEST: 2022
GRADED A
i. Act as thrombopoietin receptor agonists ( PT production)
e) Danazol (Danocrine) - immune response
2) Splenectomy – anti-PT antibodies, PTs
a) Use if pt is unresponsive to meds
b) Laparoscopic procedure, results in complete or partial remission
3) PT Tranfusion – PTs if life-threatening hemorrhage, PT
10,000/µL or anticipated bleeding preop
a) Do NOT administer prophylactically
b) Epsilon-aminocaproic acid (Amicar) – antifibrinolytic agent used for severe
bleeding
4. Thrombotic Thrombocytopenic Purpura (TTP-HUS) – uncommon; characterized by
hemolytic anemia, thrombocytopenia and neurologic abnormalities, fever w/o infection, renal
abnormalities
a. Caused by plasma enzyme (ADAMTS13) deficiency which usually breaks down von
Willebrand clotting factor unusually
large vWF to attach onto PTs promoting PT aggregation
b. Can be triggered by drug toxicities (chemotherapy, cyclosporine, quinine, oral
contraceptives, valacyclovir (Valtrex), clopidogrel (Plavix)), pregnancy, preeclampsia,
infection, or autoimmune disorder (SLE, sclerodoma)
c. Medical EMERGENCY! – bleeding and clotting can occur at the same time!
d. Interventions:
1) Plasma exchange – to aggressively reverse PT consumption by supplying vWF
and ADAMTS13 and removing large vWF that bind w/ PTs
2) Continued daily until PT normalizes and hemolysis stops
3) Can use adjunctive meds – corticosteroids, rituximab, cyclosporine,
cyclophosphamide
4) Splenectomy – for pts refractory to plasma exchange or immunosuppression
5) PT Transfusion – CONTRAINDICATED! clotting
5. Heparin-Induced Thrombocytopenia (HIT)/heparin-induced thrombocytopenia
and thrombosis syndrome (HITTs) – thrombocytopenia develops 5-10 days after
hepatin therapy
a. Should be expected if PT count has decreased more than 50% or below 150,000/µL
,MS STUDY GUIDE WEEK 2 AND 3 CORRECT Q AND A LATEST: 2022
GRADED A
b. Can lead to – venous thrombosis, arterial thrombosis, DVT, PE, arterial vascular infarcts
(skin necrosis), stroke, end-organ damage
c. Causes PT destruction and vascular endothelial injury more Heparin is needed to maintain
therapeutic aPTT
d. Interventions
1) Discontinue heparin and heparin flushes to vascular catheters when s/s of HIT
develop. Mark on medical record!
2) To maintain anticoagulation - direct thrombin inhibitor
(lepirudin/Refludan, argatroban Acova, fondaparinux/Arixtra)
3) Only start warfarin if PT count has reached 150,000/µL
4) If severe clotting:
, MS STUDY GUIDE WEEK 2 AND 3 CORRECT Q AND A LATEST: 2022
GRADED A
a) Plasmapheresis – to clear PT-aggregating IgG from blood
b) Protamine sufate – to interrupt circulating heparin
c) Thrombolytic agents – to treat thromboembolic events
d) Surgery – to remove clots
1) PT Transfusions – ineffective! thrombosis
6. Diagnos
tics
GRADED A
I. Week 2 – CAD, EKG, HF, Thrombocytopenia, Stable Angina, Atrial Rhythms
A. Thrombocytopenia – reduction of platelets below normal
1. Commonly caused by herbs or drugs that cause accelerated PT destruction via drug-dependent
antibodies which attack platelets when bacteria/virus attaches onto PT surface
2. S/S
a. Bleeding: cutaneous (petechiae, purpura, ecchymoses) OR mucosal (epistaxis,
gingival bleeding, large bullous hemorrhages)
b. Prolonged bleeding or signs of internal bleeding (weakness, fainting, dizziness, tachycardia,
abdominal pain, hypotension)
3. Immune Thombocytopenic Purpura/Idiopathic Thrombocytopenic Purpura (ITP) – most
common; abnormal destruction of circulating PTs
a. PTs are covered with antibodies which, once reaching the spleen, are recognized as foreign
and destroyed by
macrophages
b. Can be caused by infections (H. pylori, viral infections, etc)
c. PT’s survival is shortened (normal: 8-10 days)
d. Interventions
1) (Only intervene if pt is symptomatic OR PT is below 30,000/µL)
2) Avoid aspirin and other meds that affect coagulation
e. Treatments:
1) Meds:
a) Corticosteroids (methylprednisolone) – suppresses antibody
formation and reduces capillary leakage
b) IV Immunoglobulin (IVIG), anti-D, WinRho – competes with anti-PT
antibodies for macrophage
receptors
i. Use IF pt is unresponsive to corticosteroids, splenectomy, or cannot
have splenectomy
c) Rituximab – lyse activated B cells reducing immune recognition of PTs
d) Romiplostin (Nplate), eltrombopag (Promacta) – for pts w/ chronic ITP
w/ insufficient response to meds or contraindication to splenectomy
,MS STUDY GUIDE WEEK 2 AND 3 CORRECT Q AND A LATEST: 2022
GRADED A
i. Act as thrombopoietin receptor agonists ( PT production)
e) Danazol (Danocrine) - immune response
2) Splenectomy – anti-PT antibodies, PTs
a) Use if pt is unresponsive to meds
b) Laparoscopic procedure, results in complete or partial remission
3) PT Tranfusion – PTs if life-threatening hemorrhage, PT
10,000/µL or anticipated bleeding preop
a) Do NOT administer prophylactically
b) Epsilon-aminocaproic acid (Amicar) – antifibrinolytic agent used for severe
bleeding
4. Thrombotic Thrombocytopenic Purpura (TTP-HUS) – uncommon; characterized by
hemolytic anemia, thrombocytopenia and neurologic abnormalities, fever w/o infection, renal
abnormalities
a. Caused by plasma enzyme (ADAMTS13) deficiency which usually breaks down von
Willebrand clotting factor unusually
large vWF to attach onto PTs promoting PT aggregation
b. Can be triggered by drug toxicities (chemotherapy, cyclosporine, quinine, oral
contraceptives, valacyclovir (Valtrex), clopidogrel (Plavix)), pregnancy, preeclampsia,
infection, or autoimmune disorder (SLE, sclerodoma)
c. Medical EMERGENCY! – bleeding and clotting can occur at the same time!
d. Interventions:
1) Plasma exchange – to aggressively reverse PT consumption by supplying vWF
and ADAMTS13 and removing large vWF that bind w/ PTs
2) Continued daily until PT normalizes and hemolysis stops
3) Can use adjunctive meds – corticosteroids, rituximab, cyclosporine,
cyclophosphamide
4) Splenectomy – for pts refractory to plasma exchange or immunosuppression
5) PT Transfusion – CONTRAINDICATED! clotting
5. Heparin-Induced Thrombocytopenia (HIT)/heparin-induced thrombocytopenia
and thrombosis syndrome (HITTs) – thrombocytopenia develops 5-10 days after
hepatin therapy
a. Should be expected if PT count has decreased more than 50% or below 150,000/µL
,MS STUDY GUIDE WEEK 2 AND 3 CORRECT Q AND A LATEST: 2022
GRADED A
b. Can lead to – venous thrombosis, arterial thrombosis, DVT, PE, arterial vascular infarcts
(skin necrosis), stroke, end-organ damage
c. Causes PT destruction and vascular endothelial injury more Heparin is needed to maintain
therapeutic aPTT
d. Interventions
1) Discontinue heparin and heparin flushes to vascular catheters when s/s of HIT
develop. Mark on medical record!
2) To maintain anticoagulation - direct thrombin inhibitor
(lepirudin/Refludan, argatroban Acova, fondaparinux/Arixtra)
3) Only start warfarin if PT count has reached 150,000/µL
4) If severe clotting:
, MS STUDY GUIDE WEEK 2 AND 3 CORRECT Q AND A LATEST: 2022
GRADED A
a) Plasmapheresis – to clear PT-aggregating IgG from blood
b) Protamine sufate – to interrupt circulating heparin
c) Thrombolytic agents – to treat thromboembolic events
d) Surgery – to remove clots
1) PT Transfusions – ineffective! thrombosis
6. Diagnos
tics
