"...Penias" Flashcards
(22 cards)
What is thrombocytopenia?
Platelet count <150 From: ↓Production ↑Consumption ↑Destruction Pooling in an enlarged spleen
What are the causes of thrombocytopenia?
- Congenital: Fanconi’s, Leukaemia, Wiskott-Aldrich, Bernard-Soulier
- ↓Production: EBV, Rubella, Mumps, HIV, Aplastic anaemia, Ca, OH-, Chemo, ALL
- ↓Survival: ITP, SLE, RA, Sarcoid, DIC, HUS, HELLP, immune thrombocytopenia- SCREEN FOR HIV!
- Platelet dysfunction: vWD, CKD, Myeloma
- ↑Consumption: DIC, TTP, massive haemorrhage
How does thrombocytopenia present?
Spont bruising Epistaxis Bleeding gums Petechiae/Purpura/Ecchymoses Bleeding w/Aspirin & NSAIDs
What are the red flags Sx for severe thrombocytopenia?
Haemoptysis Haematemesis Haematuria Haematochezia Melaena
How is thrombocytopenia investigated?
Bloods: FBC & Clotting studies
Blood Smear
>60yo = BM Exam
How is thrombocytopenia managed?
Conservative: Monitor every few months
Admission: Platelet transfusion
What are the indications for hospital admission with thrombocytopenia?
Platelets <20
Bleeding or bruising
Abnormal examination
Concomitant anaemia/neutropenia
What is pancytopenia?
LOW RBC
LOW Platelets <150
LOW WBC
What are the causes of pancytopenia?
Deficiency: Aplastic anaemia, Folate/B12 def
Infection: HBV, EBV, Parvovirus
Drugs: Trimethoprim, Carbimazole, Carbamazepine, Chloramphenicol, Tolbutamide
Cancer: Lymphoma, Myeloma
What is the most likely diagnosis for someone with BM failure & pancytopenia?
Myeloma
How does pancytopenia present?
Symptoms of: -Anaemia: Dyspnoea, fatigue, pale, tachy -Neutropenia: Infections -Thrombo: Epistaxis, bruising, bleeding Hepatosplenomegaly & lymphadenopathy
What is the most likely diagnosis for someone with Hepatosplenomegaly, lymphadenopathy & pancytopenia?
Leukaemia
What cause of thrombocytopenia is most likely in someone who present with bleeding gums?
Von Willebrand Disease
How is pancytopenia investigated?
FBC
How is pancytopenia managed?
Transfusion: RBC & Platelets
+/- BM Transplant
What is the difference between neutropenia & febrile neutropenia?
N = Absolute neutrophil count of <1.0×109/L
Febrile N = > 38oC + absolute neutrophil count of <1.0×109/L
What are the causes of neutropenia?
- Congenital
- BM Malignancy
- Aplastic anaemia, B12/Folate
- Drugs: Phenytoin, Chloramphenicol, OH-, RT, Chemo
- Infections: EBV, Hep B/C, HIV, CMV, Typhoid
- ↑Turnover: Malaria, Hypersplenism, Felty’s
Which patients are high risk for febrile neutropenia?
Active malignancy
Active Chemo
HIV
Immunosuppression: Azathioprine, Steroids
How is febrile neutropenia investigated?
Blood Cultures: x2 from peripheral vein AND any indwelling venous catheters
Bloods: FBC, U&E, LFT, CRP, ESR, Coag
Imaging: CXR
How is febrile neutropenia treated?
Abx WITHIN 1HOUR!
Abx: IV Tazocin (assess oral switch after 48hours)
IV Fluids
Which patients are contraindicated for oral antibiotics in suspected febrile neutropenia?
Pneumonia Acute leukaemia Evidence of organ failure Indwelling venous catheter Severe soft tissue infection
How does bone marrow failure present?
Anaemia
Neutropenia
Thrombocytopenia
