Thrombocytopenia

Questions discussed in this category

How do you approach an ITP patient who responds very well to steroids but the response is short-lived?

How would you counsel the patient if he/she wants to continue on steroids?

3 Answers available

How do you approach anticoagulation in the setting of HIT and thrombocytopenia?

I.e. platelet count <30. Would your management change if HIT were only suspected rather than confirmed?

1 Answer available

Is there a role for rituximab in refractory HIT?

1 Answer available

How do you approach evaluation for underlying rheumatologic disease in patients with chronic asymptomatic thrombocytopenia?

Thrombocytopenia is moderate (80-100,000 microL). No concomitant cytopenias present.

1 Answer available

In a patient with a history of HIT, how would you reintroduce Heparin?

Is it only done when heparin is used in an emergency?

1 Answer available

Is there a platelet count threshold when you would avoid performing a kidney biopsy in patients with thrombocytopenia?

1 Answer available

How do you approach a persistently elevated mean platelet volume and immature platelet fraction in an otherwise healthy patient with a normal platelet count?

Provided that the platelet count is normal, do you usually consider this to be a potential erroneous result or do you pursue additional workup for RBC...

1 Answer available

When should you use caplacizumab in the treatment of acute TTP patients?

1 Answer available

Is there a correlation between spleen size and degree of thrombocytopenia?

1 Answer available

How do you approach very treatment-refractory ITP?

Such as the case in which a patient is unresponsive to steroids, IVIG, TPO-agonist, rituximab, splenectomy, and even fostamitinib.

1 Answer available

Do you transfuse platelets prior to central line placement in patients with platelet counts less than 50,000?

1 Answer available

Below what platelet count would you avoid using an AV fistula in a patient with ESKD and thrombocytopenia?

1 Answer available

What are your options for refractory ITP after steroids and TPO for elderly patients?

1 Answer available

How do you approach a patient with chronic low ADAMTS13 activity and low level of inhibitor without signs of thrombocytopenia or hemolysis?

ADAMTS13 level <5% Inhibitor level <1

1 Answer available

How do you explain TTP to patients?

1 Answer available

Based on recent data would you consider adding ATRA to low dose rituximab for steroid refractory ITP?

Wu et al., PMID 34665865

1 Answer available

At what platelet count would you feel comfortable dosing aspirin 81 mg for coronary artery disease in a patient with ITP?

Presuming strong indication for ASA - eg history of NSTEMI

1 Answer available

To what extent does the degree of thrombocytopenia correlate with the severity of cirrhosis?

1 Answer available

Would you give a TPO agonist for thrombocytopenia in alcoholic cirrhosis?

1 Answer available

How do you manage drug-induced thrombocytopenia when the implicated drug is essential?

e.g. DITP from eptifibatide after a cardiac intervention

1 Answer available

For treatment of ITP, what would you add to dexamethasone to achieve the fastest recovery in a patient waiting for a procedure?

IVIG, TPO, or other agents?

1 Answer available

Do you routinely check platelet counts after COVID-19 vaccines in patients with chronic ITP?

1 Answer available

With what agents can you replace PPIs if they cause thrombocytopenia?

1 Answer available

Should platelet transfusions be considered for anti-platelet agent reversal in patients with major bleeding?

1 Answer available

How long do you continue caplacizumab in relapsed refractory TTP?

How often do you monitor ADAMTS-13 levels off therapy?

1 Answer available

Are there any reasons to consider a prolonged course of steroids with taper over a shorter course of pulsed steroids in the treatment of ITP?

For example, do we prefer one regimen over the other in patients with a bleeding history or who have relapsed after a lengthy remission?

1 Answer available

How do you approach the treatment of drug-induced thrombotic microangiopathy?

When do you consider initiating eculizumab?

1 Answer available

What is your approach to platelet transfusion in heparin induced thrombocytopenia?

Does having a concurrent consumptive process e.g. DIC change your management?

1 Answer available

How would you advise patients with known stable autoimmune thrombocytopenia regarding the Ad26.COV2.S (Johnson & Johnson/Janssen) vaccine?

1 Answer available

When (if ever) do you check for anti-platelet antibodies for workup of thrombocytopenia?

1 Answer available

Is there a role for prophylactic tranexamic acid in patients with hematologic malignancy with chemotherapy-induced thrombocytopenia?

1 Answer available

How do you approach the treatment of ITP in a pregnant patient who did not respond to prednisone?

Would you consider high-dose dexamethasone (deliberating adverse effects of antenatal steroids) or move to next-line therapies?

1 Answer available

What is your approach to treating refractory thrombocytopenia in lupus?

2 Answers available

How do you manage thrombocytopenia when radiating the spleen?

At what point would you recommend transfusion? At what point would you stop radiation?

1 Answer available

Papers discussed in this category

Blood, 2021 Apr 01

Real-world experience with caplacizumab in the management of acute TTP.

Blood, 2015 May 13

A novel triple therapy for ITP using high-dose dexamethasone, low-dose rituximab, and cyclosporine (TT4).

Blood, 2009 Nov 06

Combination immunosuppressant therapy for patients with chronic refractory immune thrombocytopenic purpura.

Blood,

Adenovirus-induced thrombocytopenia: the role of von Willebrand factor and P-selectin in mediating accelerated platelet clearance.

J Pharm Pract, 2019 Mar 27

Lansoprazole-Induced Thrombocytopenia in a Critically Ill Patient: A Case Report.

Journal of vascular and interventional radiology : JVIR, 2012 Apr 17

Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions.

Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis, 2013-10

Refractory heparin induced thrombocytopenia with thrombosis (HITT) treated with therapeutic plasma exchange and rituximab as adjuvant therapy.

Journal of clinical medicine, 2023 Nov 03

Autoimmune Heparin-Induced Thrombocytopenia.

Blood, 2018 Sep 10

Preemptive rituximab prevents long-term relapses in immune-mediated thrombotic thrombocytopenic purpura.

American journal of kidney diseases : the official journal of the National Kidney Foundation, 2013-01

Thrombocytopenia associated with one type of polysulfone hemodialysis membrane: a report of 5 cases.

Seminars in dialysis, 2014

Thrombocytopenia in ESRD patients: epidemiology, mechanisms and interventional nephrology perspective.

Kidney Int, 2012 May 16

Hemodialysis effect on platelet count and function and hemodialysis-associated thrombocytopenia.

European journal of haematology, 2003-08