Keywords: Thrombocytopenia (PubMed Search)
Management of Heparin-Induced Thrombocytopenia (HIT)
HIT occurs when antibodies form to a Heparin-Platelet Factor 4 (PF4) complex in patients who have been exposed to Heparin.
The main clinical manifestation is thrombosis (arterial/venous). Treatment is unique in that only certain medications can be used.
Medical Management options in HIT:
So, when a patient with a history of HIT shows up in the ED with a DVT/PE or other thrombotic problem, these are your mainstay drugs.
Keywords: multiple myeloma, altered mental status, hyperviscosity syndrome (PubMed Search)
Multiple Myeloma + Altered Mental Status=Hyperviscosity Syndrome
Although the differential diagnosis of altered mental status is quite extensive, a patient with multiple myeloma and altered mental status should prompt consideration of one important, albeit not too common, condition.....hyperviscosity syndrome.
Some important pearls:
Keywords: Neutropenic Entercolitis (PubMed Search)
A neutropenic cancer patient that presents with right lower quadrant abdominal pain, fever, and bloody diarrhea should raise suspicion for typhlitis (necrotizing colitis, cecal inflammation). This most commonly occurs in patients with hematologic malignancies who have been treated with cytotoxic agents. This condition is high risk and is associated with high morbidity and mortaiity.
1. D'Souza S, et al. Typhlitis as a presenting manifestation of acute myelogenous leukemia. South Med J 2000;93:218-220
2. Ellerin TB, Diaz LA. Evidence-Based Medicine-500 Clues To Diagnosis and Treatment. 2001
Keywords: Thrombotic thrombocytopenia Purpura, TTP (PubMed Search)
Just a quick remainder that Thrombotic thrombocytopenia Purpura, TTP, is typically described as a pentad of symptoms:
Not all symptoms need to be present and it would be rare for you to see the full pentad. Consider the diagnosis and request that the lab due a manual differentiation or blood smear. It is there that they will notice schistocytes, fragmented RBCs, that will help clinch the diagnosis.
Most cases of TTP are idiopathic (~60%) but secondary TTP is known to occur with cancer, pregnancy, HIV, bone marrow transplantation, immunospressive drugs like cyclosporin and tacrolimus, and platelet aggregation inhibitors such as cloperidol.
Treatment consists of plasmapheresis, plasma exchange, immunospression with steroids, Rituximab, and other chemotherapies.