The Fellow on Call: The Heme/Onc Podcast Episode 015: Heme/Onc Emergencies, Pt. 4: Immune thrombocytopenic purpura
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May 18, 2022 AI Snips
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Confirm True Low Platelets
- Always confirm a very low platelet count with a repeat CBC and peripheral smear to rule out clumping artifact or other causes.
- Evaluate for schistocytes to exclude thrombotic microangiopathies like TTP and do coagulation studies to assess for DIC.
Use Post-Transfusion Platelet Test
- Transfuse a unit of platelets then check platelet count 30 to 60 minutes later to assess if platelets improve or remain low.
- Lack of platelet increment supports immune destruction as seen in ITP, but this test is not definitive alone.
Treat Severe ITP Rapidly
- Treat acute severe ITP with IVIG 1g/kg daily for 2 days plus dexamethasone 40mg daily for 4 days for rapid platelet recovery.
- Steroids alone are acceptable if platelet count is moderately low and rapid response is less critical.