๐—ก๐—ถ๐—ต๐—ฎ๐—ฟ ๐——๐—ฒ๐˜€๐—ฎ๐—ถ

๐—ก๐—ถ๐—ต๐—ฎ๐—ฟ ๐——๐—ฒ๐˜€๐—ฎ๐—ถ

02-11-2022

07:06

You are a young #medicine resident, you recieve a call from your surgery colleague ๐Ÿ“ž The patient posted for surgery has THROMBOCYTOPENIA (TCP) ๐Ÿ˜ฒ๐Ÿ˜ญ Here's what you need to know ๐Ÿ‘‡๐Ÿผ #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 ๐Ÿ’ช๐Ÿผ 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

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 ๐Ÿ‘‡๐Ÿผ 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

Always take a detailed DRUG HISTORY, including h/o alternate medicationโœ… Heparin flushes for those w/ central lines- often overlooked. HIT is RARE, calculate 4T score. If โ‰ฅ6, the probability is high and needs confirmation. STOP all heparin ASAP, screen for thrombosis! 6/12

What we've learnt till now: ๐Ÿ”ธ<150k is TCP ๐Ÿ”ธBLood smear is important ๐Ÿ”ธRapidity of fall is important ๐Ÿ”ธDrugs are common culprits ๐Ÿ”ธHIT 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 โœ… 8/12

What if the patient has TCP but also THROMBOSIS ๐Ÿ˜ฒ What's the ddx here ? ๐Ÿ”ธHIT ๐Ÿ”ธDIC ๐Ÿ”ธTTP ๐Ÿ”ธAPLA 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

Oh, wait !! Did I forget to tell you the patient is pregnant ๐Ÿคฐ #MedTwitter 10/12

DDx of TCP in pregnancy: ๐Ÿ”ธGestational TCP ๐Ÿ”ธITP ๐Ÿ”ธHELLP ๐Ÿ”ธPre-eclampsia ๐Ÿ”ธTTP ๐Ÿ”ธDIC and the rest !! Never think gestational TCP if platelets <50k ! #MedTwitter 11/12

Let's summarise: ๐Ÿ”ธExclude pseudoTCP (Blood film) ๐Ÿ”ธDrug history โœ… ๐Ÿ”ธClinical context (sick vs not sick) ๐Ÿ”ธDegree & rapidity of developing TCP ๐Ÿ”ธSigns of bleeding/Thrombosis If you read the whole thread ๐Ÿ‘‡๐Ÿผ #MedTwitter 12/12



Follow us on Twitter

to be informed of the latest developments and updates!


You can easily use to @tivitikothread bot for create more readable thread!
Donate ๐Ÿ’ฒ

You can keep this app free of charge by supporting ๐Ÿ˜Š

for server charges...