Thread by @HermelinMD

A 23-year-old woman w/ a history of SLE was admitted to the hospital w/ abdominal pain & headache. Purpura is seen on her chest & thighs. Hb /Hct= 8.3,28.4, PLT= 7,000, LDH = 952, Hapto = <8, Ind Bili = 1.2, Cr = 1.2 PT/INR = 1.3. 👇🏼Take a look at her peripheral smear.

⁉️Based on the initial lab results and the peripheral smear findings above, what is your differential? #PathTweetorial #Blooducation #ApheresisRounds

The findings above (evidence of hemolysis, drop in platelet count & schistocytes on the peripheral smear) point to a thrombotic microangiopathic hemolytic anemia (TMA). The classic diseases that fall under this category are #TTP & #HUS. Let's review how we manage these patients

Since you are the #BloodBankResident on-call, the Heme-Onc Fellow paged you for #ApheresisConsult and requests immediate TPE for suspected TTP. Since you are savvy resident, you calculate the #PLASMICScore, which predicts which of the following?

🙌🏼You got it! The #PLASMICScore is a novel validated scoring system that uses several criteria to determine the probability of ADAMTS13 activity being <10% (deficient) in patients presenting w/ #TMA. Our patient has a high predictive score. Article 👉🏼bloodjournal.org/content/124/21

⌚️Time for the line! 🔑One of the most important elements of #apheresis procedures is venous access. It also the rate limiting step of the process. @keithppereira (interventional radiologist) explains instructs us on type of line needed to be ordered and how do deal w/ low PLTS.

Now that a central line has been placed, it's time to consent the patient and place the orders including prepare and transfuse FFP. What information do you need to calculate the volume of FFP?

👍🏼That's right, the replacement volume is calculated from the patient's weight (kg) and their hematocrit.
🧮👉🏼70 x patient's weight (kg) = #TotalBloodVolume
Total Blood Volume x (1-Hct) = #TotalPlasmaVolume = replacement volume needed for the procedure. #ApheresisNurse #BB

#TPE requires a multifaceted team. What's your role in #Apheresis? Please share your experiences below. 🙏🏼Thank you

3/7 photos.
No people or explanations. Thanks to @Haemovigilante, sharing the challenge with @BldCancerDoc