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Med Surg 2 > 30 - Hematologic Problems > Flashcards

30 - Hematologic Problems Flashcards

1
Q

normal platelet count

A

150-400k

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2
Q

thrombocytopenia count

A

less than 150k

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3
Q

impaired platelet production can be caused by….

A
  • cancer/disorders
  • aplastic anemia
  • drugs (chemo +)
  • immune thombocytopenia
  • infections
  • nutrnl deficency/alcoholism
  • radiation
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4
Q

incr platelet destruction can be caused by…

A
  • artificial surfaces (hemodyalysis, etc)
  • DIC
  • heparin
  • pregnancy
  • thrombotic microangiopathy (TTP, atypcl hemolytc UREMIC synd)
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5
Q

most common cause of accelerated platelet destruction

A

antibodies

-attacks pltlt when the drug binds to pltlt surface

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6
Q

most common acquired thrombocytopenia

A

IMMUNE thrombocytopenia [ITP]

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7
Q

ITP results fr

A
  • antipltlt antibodies
  • impaired pltlt productn
  • T-cell mediated destruction of pltlt
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8
Q

ITP MOA

A

platelets are coated w antibodies> spleen thinks they are foreign + destroys them w macrophages

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9
Q

platelets normally survive..

A

8-10 days

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10
Q

possibly causes of ITP

A
  • H.pylori
  • HIV
  • SLE
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11
Q

thrombotic thombocytopenic purpura [TTP]

A

-assoc w deficiency of ADAMTS13 enzyme
-w/o the enzyme, unusually large amt of vWF attach to pltlt
»>promotes aggregation
-clotting + bleeding occur at same time
-MEDICAL EMERGENCY

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12
Q

ADAMTS13

A

plasma enzyme

-breaks down the vWF clotting factr

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13
Q

vWF

A

von Willebrand clotting Factor

-most important protein-mediating platelet adhesion to damaged endothelial cells

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14
Q

TTP is often assoc w…

A

hemolytic uremic syndr

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15
Q

TTP is characterized by…

A

hemolytic anemia

  • thrombocytopenia
  • neurologc abnormalities
  • fever
  • renal abnormalities
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16
Q

Heparin Induced Thrombocytopenia [HIT]

A
  • platelet destruction + vascular endothelial injury are immune mediated response to heparin
  • life threatening
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17
Q

HIT should be suspected if…

A

pltlt count falls by more than 50% or falls below 150k

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18
Q

major problem of HIT

A

venous thrombosis

-arterial thrombosis can occur too

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19
Q

HIT complications

A
  • venous thrombosis

- arterial vascular infarcs> necrosis, stroke, end-organ damage

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20
Q

symptoms of bleeding w HIT are ___ bc…

A
  • unusual

- pltlt RARELY drops below 20k

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21
Q

HIT develops ____ after heparin therapy

22
Q

HIT MOA

A 
PF4 binds to heparin> 
then binds to pltlt>
pltlt activation> 
more PF4 released (pos feedback loop)>
antibodies are made against PF4-heparin-pltlt complx>
removed prematurely fr circultn>
thombocytopenia + pltlt-fibrin thrombi
23
Q

thrombocytopenia clinical manifestations

A
  • mostly asymptomatic
  • bleeding in mucosal or cutaneous
  • large bullous hemorrahge in buccal mucosa
  • bleeding into skin (petechiae, purpura, ecchymosis)
  • hemorrhage
24
Q

bleeding in mucosa examples

A

nosebleed + gingival bleeding

25
bleeding into skin (petechiae, purpura, ecchymosis) | MOA
when pltlt count is low, RBC may leak out of blood vssls, + into skin
26
manifestations that indicate internal blood loss
- weakness - fainting - dizziness - tachycardia - ab pain - HYPO tension
27
manifestations that indicate vascular ischemic problems/vascular thrombosis
- confusion - headache - seizure - coma
28
prolonged bleeding fr trauma/injury does NOT usually occur until platelets are less than....
50k
29
spontaneous, life-threatening hemorrhages occur when count is less than..
20k
30
platelet transfusions are not recommended unless it is below...
10k
31
ITP lab results
-extreme low pltlt
32
ITP tests
- IgG assay - pltlt actvtn functn assay - H pylori - hep C - HIV - bone marrow biopsy
33
TTP lab results
-medium decr in pltlt incr in schistocytes, reticulocytes, LDH, bilirubin decr in HgB, haptoglobin
34
TTP tests
- ADAMTS13 - urinalysis for protein, blood - creatinine - LDH may help establish diagnosis
35
HIT lab results
- slight decr in pltlt | - maybe incr in schistocytes
36
HIT tests
- pltlt activatn functn assay | - PF4-heparin-platelet complex (antigen assay)
37
when destruction is the cause, bone marrow analysis will show ____. when decreased production is the cause, bone marrow analysis will show _____.
DSTRCTN: normal or increased megakaryocytes DECR PRDCTN: absence or decr megakaryocytes
38
Plasmapheresis is indicated for....
TTP + HIT
39
....... are indicated for ITP + TTP
- corticosteroids - rituximab - splenectomy - immunosuppressive
40
ITP tx
-IVIG -corticosteroids -rituximab -splenectomy -immunosuppressive -anti Rh -platelet transfusion romiplostim, eltrombopag, epsilon-aminocaproic acid
41
TTP Tx
- plasmapheresis - corticosteroids - rituximab - splenectomy - immunosuppressive * *ID + Tx of cause
42
HIT Tx
- direct thrombin inhibitor (ARGATOBRAN) - indirect thrombin inhibtr (FONDAPARINUX) - synthtc thrombin inhibitor (BIVALIRUDIN) - plasmapheresis - thombolytic agents - warfarin
43
corticosteroids are used to treat ITP bc...
- suppress phagocytic response to splenic macrophage - depress antibody formation - reduce capillary leakage
44
IVIG or anti-Rh are given ITP bc...
- pt is unresponsive to corticostrds or splenectomy | - competes w antiplatlet-antibodies for macrophage receptors in spleen
45
thrombopoietin receptor agonists that are given to ITP...
-romiplostim -eltrombopag >>>incr pltlt production
46
example of immunosuppressive therapy
cyclosporine or cyclophosphemide
47
if untreated, TTP usually results w...
renal disorder + death
48
plasmapheresis works by providing TTP pts with _____ + removing_____. it also works w HIT by removing....
ADAM13 + approp vWF, lrg vWF enzymes that are bound w pltlt. platelet aggregating IgG fr blood
49
platelet transfusion is CI with...TTP + HIT
bc it may bind + create more clotting
50
warfarin for ___ should only be started when ____
HIT | -pltlt count has reached 150k

Med Surg 2 (13 decks)

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