Post-transfusion sequelae - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-24-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 196
Threads: 9
Thanked 97 Times in 64 Posts
Reputation: 107
Blood Post-transfusion sequelae

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:

Post-transfusion sequelae-skin-rash.jpg
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
Reply With Quote Quick reply to this message
The above post was thanked by:
..sharma (06-24-2012)



  #2  
Old 06-24-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 790
Threads: 76
Thanked 672 Times in 316 Posts
Reputation: 690
Default

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

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Matched!!!
Reply With Quote Quick reply to this message
  #3  
Old 06-24-2012
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 452
Threads: 11
Thanked 354 Times in 197 Posts
Reputation: 364
Default

A.....its DIC
Reply With Quote Quick reply to this message
  #4  
Old 06-24-2012
USMLE Forums Addict
 
Steps History: CS Only
Posts: 127
Threads: 8
Thanked 43 Times in 32 Posts
Reputation: 53
Default

post transfusion purpura ...... Pl-A1 antigen
Reply With Quote Quick reply to this message
  #5  
Old 06-25-2012
curiousmind's Avatar
USMLE Forums Scout
 
Steps History: ---
Posts: 82
Threads: 5
Thanked 21 Times in 15 Posts
Reputation: 31
Default

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
Reply With Quote Quick reply to this message
  #6  
Old 06-25-2012
USMLE Forums Addict
 
Steps History: CS Only
Posts: 127
Threads: 8
Thanked 43 Times in 32 Posts
Reputation: 53
Default

post transfusion purpura normally occurs 7-10 days after a transfusion ..... sounds more like it ...... anyways waiting for the answer
Reply With Quote Quick reply to this message
  #7  
Old 06-26-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 307
Threads: 36
Thanked 127 Times in 61 Posts
Reputation: 137
Default

DIC would be first option (D-Dimer ie.)
What about option 4? Could be HIT?
Reply With Quote Quick reply to this message
  #8  
Old 06-26-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 125
Threads: 17
Thanked 66 Times in 38 Posts
Reputation: 76
Default

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
Reply With Quote Quick reply to this message
  #9  
Old 06-26-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 125
Threads: 17
Thanked 66 Times in 38 Posts
Reputation: 76
Default

Quote:
Originally Posted by irakly View Post
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
Reply With Quote Quick reply to this message
  #10  
Old 06-29-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 196
Threads: 9
Thanked 97 Times in 64 Posts
Reputation: 107
Default

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.



Sent from my Desire HD
Reply With Quote Quick reply to this message
The above post was thanked by:
ehtisham (06-29-2012)
  #11  
Old 06-29-2012
USMLE Forums Addict
 
Steps History: CS Only
Posts: 127
Threads: 8
Thanked 43 Times in 32 Posts
Reputation: 53
Default

There is a table in goljan it explains all forms of thrombocytopenias very nicely with typical scenarios
Reply With Quote Quick reply to this message



Reply

Tags
Figures-, Hematology-, Pathology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
RBC Transfusion Cross matching mayursn39 USMLE Step 1 Forum 7 10-02-2011 12:05 AM
Transfusion reaction mayursn39 USMLE Step 1 Forum 6 09-30-2011 08:13 AM
Blood Transfusion Hypersensitivity Reaction! ricko335 USMLE Step 1 Forum 7 08-21-2011 09:05 AM
Sequelae of Fracture drgsarunprasath USMLE Step 1 Forum 8 08-15-2011 03:53 AM
No Blood Transfusion Reaction! aktorque USMLE Step 1 Forum 15 02-23-2011 09:13 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)