po
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A 50 year old female presents with a one week history of fever with episodes of disorientation. A CBC shows hemoglobin 11.0 g/dL. hematocrit 32.9%, MCV 99 fL, platelet count 14,000/microliter, and WBC count 8900/microliter. Schistocytes are seen on the peripheral blood smear. Serum chemistries show sodium 148 mmol/L, potassium 5.6 mmol/L, chloride 107 mmol/L, CO2 28 mmol/L, glucose 110 mg/dL, creatinine 3.3 mg/dL, urea nitrogen 45 mg/dL, AST 285 U/L, ALT 55 U/L, alkaline phosphatase 33 U/L, total bilirubin 4.7 mg/dL, direct bilirubin 0.5 mg/dL, and albumin 3.5 g/dL. Her condition markedly worsens following transfusion of a "six pack" of platelets. The condition most likely to cause these findings is:
A) Plasmodium falciparum infection
B) Thrombotic thrombocytopenic purpura
C) Hereditary spherocytosis
D) Wegener's granulomatosis
E) Acute alcoholic hepatitis
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| new_n_lost
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B) Thrombotic thrombocytopenic purpura
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| tompat
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c. TTP,
note the pentad: fever, low platelet,cns involvement and renal failure and hemolytic anemia with schistocytes.
here cns findings predominate clinically.vWf cleaving metalloprotease is deficient, genetic or acquired cuz.
had the same s/s present in a kid who eat beef it wud be HUS,only diff is of age of presentation and cns involvement is less in HUS.
ticlopidin a platelet inhibitor can also lead to TTP.ticloidine acts like clopidogrel.
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| doc179
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TTP
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| po
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now antiplatelets,I get confused easily so here is the list.
1.COX inhibitors-we all know aspirin
2.Phosphodiesterase 3 inh-dipyridamole,cilostazol[dual mech of action-1.prolong the action of PDE,2.prevent uptake of adenosine which inturn thru A2receptors increase platelet cAMP Both 1&2 are aimed at platelet cAMP LOW.]
3.ADPreceptor antagonists-ticlopidine , clopidogrel[inh of ADP mediated aggregation]
4.glycoprotein IIb/IIIa receptor inh-abciximab,tirofiban,eptifibatide[block reversibly this receptor that is involved in platelet cross linking with fibrin]
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| tompat
Forum Elite
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in ITP THEREis antiody formation against GPIIb/IIIa
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| SmokyWaters
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welll as far as dipyrimdamole is concerned...I thought it was THROMBOXANE SYNTHASE inhibitor ....correct me if I am wrong..
its TTP...the pentad correctly mentioned already
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| po
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http://en.wikipedia.org/wiki/Dipyridamole
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| SmokyWaters
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Dipyridamole is a platelet adhesion inhibitor, although the mechanism of action has not been fully elucidated. The mechanism may relate to inhibition of red blood cell uptake of adenosine, itself an inhibitor of platelet reactivity, phosphodiesterase inhibition leading to increased cyclic-3,5-adenosine monophosphate within platelets, and inhibition of thromboxane A2 formation which is a potent stimulator of platelet activation.
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| SmokyWaters
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http://www.rxlist.com/cgi/generic/dipyrid_cp.htm
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