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of primary hemostasis ✔
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Assessing and treating disorders of primary hemostasis - The Clinical Advisor
Manifestations
of disorders of Which of the following bleeding disorders
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Assessing and treating disorders of primary hemostasis - The Clinical Advisor
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Assessing and treating disorders of primary hemostasis - The Clinical Advisor
The same organs are affected in HUS and TTP, but in HUS the
lesions are most numerous in the renal vasculature and there is
minimal neurologic dysfunction. Acute kidney injury supports a
diagnosis of HUS rather than TTP; acute renal failure affects
<5% of patients with TTP at presentation.16 Of note, in 20% of
patients with an initial presentation of atypical HUS, although
some proteinuria or hematuria may be present, renal function is
preserved.16 The lungs are almost never involved in TTP,
whereas pulmonary disease is frequent in untreated atypical
HUS.16 It is essential to differentiate between these disorders
quickly because the PEX that is standard for TTP has no role in
HUS. Overall, patients with thrombocytopenia (<150,000/µL or
>25% decrease from baseline) plus signs of microangiopathic
hemolysis and at least one manifestation of organ damage
(neurologic, renal, or gastrointestinal most commonly) should be
treated for thrombotic microangiopathy, and time-sensitive PEX
should be initiated. Subsequent laboratory analysis will confirm
the diagnosis; the detection of toxin-producing bacteria in stool
culture or via serology or the presence of an anti-0157 antibody
titer supports a diagnosis of STEC-HUS; ADAMTS13 activity
<5% to 10% is likely TTP, and if >5% to 10% is likely atypical
HUS. Further investigation of atypical HUS includes screening
for complement system abnormalities (serum C3 and C4 levels,
factor H and factor I levels). As in TTP, platelet transfusions are
strongly contraindicated in HUS unless a severe hemorrhagic
condition is present. For STEC-HUS, treatment includes
(intravenous) fluid hydration, supportive care, and hemodialysis,
with renal transplant as needed. Antibiotic therapy is not needed.
In atypical HUS, PEX is the first-line treatment per expert
opinion, although the efficacy is variable according to mutated
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Conclusion
References
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Assessing and treating disorders of primary hemostasis - The Clinical Advisor
disease (VWD).
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Reference.aspx#a3. Accessed October 26, 2017.
6. Thiagarajan P. Platelet disorders: overview of platelet disorders.
Medscape.http://emedicine.medscape.com/article/201722-
overview. Updated August 5, 2017. Accessed October 26, 2017.
7. Mohanty D, Shetty S. Von Willebrand Disease: an update. J
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8. Simon D, Kunicki T, Nugent D. Platelet function defects.
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9. Neunert C, Lim W, Crowther M, et al. The American Society of
Hematology 2011 evidence-based practice guideline for immune
thrombocytopenia. Blood. 2011;117(16):4190-4207.
10. Kessler CM. Immune thrombocytopenic purpura (ITP).
Medscape. www.emedicine.medscape.com/article/202158-
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11. Visentin GP, Liu CY. Drug-induced thrombocytopenia. Hematol
Oncol Clin North Am. 2007;21:685-696.
12. Solomon CG. Heparin-induced thrombocytopenia. N Engl J Med.
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13. Cuker A, Crowther M. 2013 Clinical practice guideline on the
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15. Scully M, Hunt B, Benjamin S, et al; British Committee for
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doi:10.1111/j.1365-2141.2012.09167.x
16. Laurence J. Atypical hemolytic uremic syndrome (aHUS): making
the diagnosis. Clin Adv Hematol Oncol. 2012;10(10 Suppl 17):1-
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17. Salvadori M, Bertoni E. Update on hemolytic uremic syndrome:
diagnostic and therapeutic recommendations. World J Nephrol.
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18. Dalainas I. Pathogenesis, diagnosis and management of
disseminated intravascular coagulation: a literature review. Eur
Rev Med Pharmacol Sci. 2008;12:19-31.
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disseminated intravascular coagulation (DIC) according to four
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