This is Part II of a 2-part lecture on TTP, DIC, and thrombocytopenia in the critically ill patient. It was given by Tom Deloughery at the EEMCrit Conference. The Essentials folks have a video package of the whole day at their site.

See Part I for Diagnosis

TTP

Never Give Platelets Never Give Platelets Never Give Platelets

Plasma Exchange is the treatment of Choice

Temporize with 2 units of Plasma, then 1 unit q6 hrs until plasma exchange

These patients will not bleed regardless of PLTs when you place the HD Cath--just do it (but not the intern)

Give Steroids (i.e. 125 mg solumedrol or similar)

 

Send ADAMSTS13 find out how long it takes and make sure it is sent before plasma exchange

 

Goals

* PLT target >150,000 on 2 draws

* normalizing LDH

* neuro sx fixed

after this, 2 more days; then cold turkey or wean

 

DIC

Treat underlying cause (duh_

Transfuse to

* Fibrinogen > 150 (200 in OB disasters) -- Give 10-pack of cryo and recheck (even in places that have fibrinogen conc.)

* PLT > 50

* HCT > 21

* PTT < 1.5 x control

* INR < 2-3

Heparin and AT III have not panned out. Only use heparin if there is macro-thrombosis (i.e. PE)

Now on to the Vodcast...