Day 3- Hemolytic Anemia

If patient presents with drop in platelets and Hb you MUST have a peripheral smear assessing for fragments to diagnosis a potential MAHA

TTP

  • Medical emergency!

  • Investigations: blood film (?are there schistocytes), thrombocytopenia, microangiopathic hemolytic anemia, high reticulocyte count, negative coombs test, high LDH, high unconjugated bilirubin (also check Cr- could be high, and INR/PTT- normal)

  • Treatment:

    • call hematology to initiate PLASMA EXCHANGE

    • plasma infusion @ 100ml/hr (goal 25-30mL/kg per day, limited by volume overload) until plasma exchange can be arranged

DIC

  • “too much thrombin”

  • thrombosis and bleeding, platelet activation, markedly elevated D-dimer, decreased fibrinogen, elevated INR/PTT

  • Treatment:

    • Involve hematology + ICU. Treat underlying cause! (Ie. sepsis, trauma, malignancy, obstetric complications, meds).

    • If bleeding, support with FFP and cryoprecipitate (keep fibrinogen >1gm/L)

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