The Fellow on Call: The Heme/Onc Podcast New Fellow Bootcamp Series: ITP
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Jun 25, 2024 As the new academic year begins, the focus is on preparing hematology/oncology fellows for their first on-call nights. The discussion covers critical topics like the workup for thrombocytopenia, distinguishing ITP from TTP, and the various diagnostic strategies. Key treatment options for ITP are explored, including the use of IVIG and corticosteroids. A unique take on the immature platelet fraction highlights its role in assessing bleeding risk, ensuring fellows are equipped with essential knowledge for managing hematologic emergencies.
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Severe thrombocytopenia case example
- A 33-year-old woman presented with severe thrombocytopenia and bleeding symptoms, platelets less than 5.
- This scenario led to urgent hematology consultation due to high risk of spontaneous bleeding like intracranial hemorrhage.
Confirm true thrombocytopenia first
- Always repeat CBC and perform a peripheral smear to confirm true thrombocytopenia.
- Check for platelet clumping and hemolysis to rule out lab artifact and other emergencies.
Narrow differential in extreme thrombocytopenia
- For platelet counts below 5, consider a narrow differential: severe DIC, TTP, HIT, or ITP.
- Use the presence of schistocytes, hemolysis, and history to help differentiate these critical causes.