Post-transfusion sequelae

[smanthrav]

A 36 year old female is admitted to the hospital in severe abdominal pain and a history of a missed period. She is found to be hypotensive and diaphoretic. A diagnosis of ruptured ectopic is made and she is then given Normal saline and 4 Units of blood. She undergoes surgery and progresses well to recovery. On the 6th PO day the nursing staff informs you that the patient has been continually oozing blood from the IV site ever since if was removed 40 minutes back. You examine the patient and find this:


Click image to enlarge

Which of these would you say you're most likely to find in the patients blood?
1. D-dimers
2. IgG against GP2b-3a receptor
3. Low vwF assay
4. IgG against PF4
5. IgG against Pl-A1 antigen

[anomali]

i guess D dimers but onset at 6th PO---i doubt that...

[DefeatTheBeast]

A.....its DIC

[ehtisham]

post transfusion purpura ...... Pl-A1 antigen

[curiousmind]

think its D dimers, picture sounds like DIC....., but question says patient recovers well. Bleeding from iv line sounds more like DIC.

plz give answer

[ehtisham]

post transfusion purpura normally occurs 7-10 days after a transfusion ..... sounds more like it ...... anyways waiting for the answer

[dockhi]

DIC would be first option (D-Dimer ie.)
What about option 4? Could be HIT?

[irakly]

D-DIMER -DIC-SCHISTOCYTES,INCREASE D-DIMERS,DECREASE FIBRINOGEN, FACTOR V AND VIII,CAUSES:SEPSIS,TRAUMA,OBSTETRIC COMPLICATIONS,PANCREATITIS,MALIGNANCY,NEPHROTIC SYNDROME,TRANSFUSION.
GpIIb-IIIa-IDIOPATHIC THROMBOCYTOPENIC PURPURA-MOST COMMON CAUSE THROMBOCYTOPENIA IN CHILDREN 2-6 Y.IgG AGAINST GpIIb-IIIa RECEPTORS .ABRUPT ONSET 1-3 WEEKS AFTER A VIRAL INFECTION ,PRESENT WITH EPISTAXIS,EASY BRUISING,PETECHIAE ,ABSENCE OF LYMPHADENOPATHY AND SPLENOMEGALY
LOW vWF-THROMBOTIC THROMBOCYTOPENIC PURPURA-OCCURS IN ADULT FEMALES,ACQUIRED OR GENETIC DEFICIENCY IN vWF -CLEAVING METALLOPROTEASE IN ENDOTHELIAL CELLS.INCREASE IN CIRCULATING MULTIMERS OF vWF INCREASES PLATELET ADHESION TO AREAS OF ENDOTHELIAL INJURY.PLATELETS ARE CONSUMED OWING TO PRODUCTION OF PLATELET THROMBI IN AREAS OF INJURY (NOT DIC).FEVER,THROMBOCYTOPENIA,RENAL FAILURE,MICROANGIOPATHIC HEMOLYTIC ANEMIA WITH SCHISTOCYTES,CNS DEFICITS
PF4-HEPARIN-INDUCED THROMBOCYTOPENIA-MOST COMMON CAUSE OF THROMBOCYTOPENIA IN HOSPITALIZED PATIENTS.MACROPHAGE REMOVAL OF PLATELETS SURFACED BY IgG ANTIBODY DIRECTED AGAINST HEPARIN ATTACHED TO PF4 .OCCURS 5-14 DAYS AFTER Rx.MAY RESULT VESSEL THROMBOSIS
PL-a1-POST-TRANSFUSION PURPURA-PRIMARILY OCCURS IN MULTIPAROUS WOMEN.SEVERE THROMBOCYTOPENIA WITH DESTRUCTION OF DONOR AND PATIENT PLATELETS OCCURS 7-10 DAYS AFTER TRANSFUSION

[irakly]

Originally Posted by irakly

D-DIMER -DIC-SCHISTOCYTES,INCREASE D-DIMERS,DECREASE FIBRINOGEN, FACTOR V AND VIII,CAUSES:SEPSIS,TRAUMA,OBSTETRIC COMPLICATIONS,PANCREATITIS,MALIGNANCY,NEPHROTIC SYNDROME,TRANSFUSION.
GpIIb-IIIa-IDIOPATHIC THROMBOCYTOPENIC PURPURA-MOST COMMON CAUSE THROMBOCYTOPENIA IN CHILDREN 2-6 Y.IgG AGAINST GpIIb-IIIa RECEPTORS .ABRUPT ONSET 1-3 WEEKS AFTER A VIRAL INFECTION ,PRESENT WITH EPISTAXIS,EASY BRUISING,PETECHIAE ,ABSENCE OF LYMPHADENOPATHY AND SPLENOMEGALY
LOW vWF-THROMBOTIC THROMBOCYTOPENIC PURPURA-OCCURS IN ADULT FEMALES,ACQUIRED OR GENETIC DEFICIENCY IN vWF -CLEAVING METALLOPROTEASE IN ENDOTHELIAL CELLS.INCREASE IN CIRCULATING MULTIMERS OF vWF INCREASES PLATELET ADHESION TO AREAS OF ENDOTHELIAL INJURY.PLATELETS ARE CONSUMED OWING TO PRODUCTION OF PLATELET THROMBI IN AREAS OF INJURY (NOT DIC).FEVER,THROMBOCYTOPENIA,RENAL FAILURE,MICROANGIOPATHIC HEMOLYTIC ANEMIA WITH SCHISTOCYTES,CNS DEFICITS
PF4-HEPARIN-INDUCED THROMBOCYTOPENIA-MOST COMMON CAUSE OF THROMBOCYTOPENIA IN HOSPITALIZED PATIENTS.MACROPHAGE REMOVAL OF PLATELETS SURFACED BY IgG ANTIBODY DIRECTED AGAINST HEPARIN ATTACHED TO PF4 .OCCURS 5-14 DAYS AFTER Rx.MAY RESULT VESSEL THROMBOSIS
PL-a1-POST-TRANSFUSION PURPURA-PRIMARILY OCCURS IN MULTIPAROUS WOMEN.SEVERE THROMBOCYTOPENIA WITH DESTRUCTION OF DONOR AND PATIENT PLATELETS OCCURS 7-10 DAYS AFTER TRANSFUSION

IgG AGAINST GpIIb-IIIa-CHRONIC ITP -MOST COMMON CAUSE OF THROMBOCYTOPENIA IN ADULT WOMEN 20-40 Y.INSIDIOUS ONSET,NEWBORN INFANTS OF MOTHERS WITH ITP MAY HAVE TRANSIENT THROMBOCYTOPENIA DUE TO TRANSPLACENTAL PASSAGE OG IgG ANTIBODIES,SECONDARY CAUSES-SLE,HIV,LYMPHOPROLIFERATIVE DISEASES

[smanthrav]

1. D-dimers-Indicate DIC, which is unlikely 6 days after a transfusion.
2. IgG against GP2b-3a receptor-Seen in ITP.
3. Low vwF assay-Seen in vwf deficiency. Its also the test we can use to differentiate vwf deficiency from Bernard soulier syndrome.
4. IgG against PF4-Heparin attached to PF4 and causes production of IgG in HIT.
5. IgG against Pl-A1 antigen-These antibodies are commonly associated with delayed purpura following transfusion. They're also seen neonatal alloimmune purpura.


Right answer is 5.



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[ehtisham]

There is a table in goljan it explains all forms of thrombocytopenias very nicely with typical scenarios