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Retired NBME 20 Answers

nbme20/Block 3/Question#28 (reveal difficulty score)
A 23-year-old woman who is 6 months pregnant ...
Antiplatelet antibodies ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—hayayah(1212)
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Heparin-induced thrombocytopenia (HIT) is the development of IgG antibodies against heparin bound platelet factor 4 (PF4). Antibody-heparin-PF4 complex activates platelets ยŽ thrombosis and thrombocytopenia. Highest risk with unfractionated heparin.

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drw  could you also help to understand: 1) could anti-heparin-PF4 complex be also called anti-PLT antibody? 2) PLT reduction is due to both PLT thrombosis consumption and elimination in the spleen, then why hypersplenism is not correct? +
charcot_bouchard  hypersplenism means bigger spleen eating everything. thats not the case here. here spleen is normal. autoimmune cause +
benitezmena  Yes I dont understand why the called them Anti-platyelet antibodies and not specifically Anti-heparin bound to PF4 on platelets. Its just not the right antibody +3
benitezmena  Antiplatelet antibodies would be for ITP, but also anti-megakaryocyte antibodies would also be for ITP. +2
misterdoctor69  As an aside, pregnancy is a hypercoagulable state which caused her DVT in the first place +1
cport12  If anyone else was freaking out about the word hemodilution basically it just means that there is a decreased concentration of cells and solids in the blood resulting from some other gain of fluid. With normal pregnancy (not HIT), blood volume increases, which results in a hemodilution. +3
kcyanide101  This question is kinda confusing... based off what i got from UWORLD there are 2 types of HIT type 1: thrombosis n thrombocytopenia. 5 days after . Usually due to sp[lenic damage type 2 You get thrombocytopenia but no thrombosis. Onset in 2 days and it is usually due to non immune process +



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