Thrombocytopenia Flashcards Preview

Internal Medicine > Thrombocytopenia > Flashcards

Flashcards in Thrombocytopenia Deck (9)
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1

Etiology overview

1. Reduced production
2. Decreased survival
3. Sequestration
4. Dilutional

2

Causes of reduced production

1. Selective impairment->durgs, infectin
2. Nutritional deficiencies
3. Bone marrow failure->aplastic anemia
4. Bone marrow replacement
5. Ineffective hematopoiesis

3

Causes of decreased survival

1. Immunological
SLE, B cell lymphoid, RA, Antiphospholipid
Infection, HIV, CMV
ITP
Drugs
Post transfusion
2. Non-immunological
DIC
Microangiopathies
++hemangiomas
HELLP

4

History if normal medical history and first time presenting with extremely low PLT count

New medication
Quinine
Infection, HIV?
Pregnancy
FHx
Rheumatological
Malignancy
Surgery/transfusion
Travel, malaria

5

If patient only has bleeding

Immune destruction
Drug/toxin

6

Clouded sensorium, renal anomalies

TTP
DIC

7

Further history

1. Easy bruising, petechiae, epistaxis, gum bleeding, GI/GU
2. Bone pain, night sweats, weight loss, nausea, anorexia, fatigue, weak, LLQ discomfort (splenomegaly)
3. fever, hemoptysis, chills, rigors, rash, laryngitis, DNV
4. Joint, arthraligia, morning stiff, malar, weight loss, cough, dyspnea, hx miscarriage, diarrheal illness (HUS), confusion and neurology (TTP)
5. Surgery, confusion/dys/cough (DIC)
6. Excess alcohol
7. Atopy, hearing loss
8. Symptoms of hypothyroid
9. Fatigue, breathless, chest pain
10. Old PLT counts
11. FHx, diet, travel, illness, vaccinations, ICU, alcohol/drugs
12. Medication history

8

Physical examination

General: petechiae, retinal hemorrhage, bleeding
1. Hepatosplenomegaly/LN+, adenopathy, bone pain/ fracture/weakness (MM), pallor
2. White spots on tongue, jaundice/+liver, retinal changes (CMV)
3. Joint deformity, LN, rash
4. Hypotension/tachy/bleed (DIC), HTN in pregnancy (HELLP), seizures/arrythmia/jaundice (TTP)
5. Bleeding at IV/catheter sites etc
6. Peripheral edema/hair loss/bradyC/hypothyroid
7. Evidence of cirrhosis/portalhypertension

9

Investigations

1. Peripheral smear
2. FBC w/ differential
3. CT head if IC bleed suspected

Results of smear determine further testing
1. Plasma electrophoresis, serum calcium, beta2mucroglobulin, BM aspirate, XR
2. Serum LDH, reticulocyte, indirect bilirubin, PT, PTT, fibrinogen, d dimer, creatinine->TTP
3. If cirrhosis suspected: LFTs, albumin, coags, ANA, ferritin, anti-SM, ceruloplasmin, USS, ammonia etc
4. CT abdomen->cirrhosis, splenomegaly, mets, lymphoma
5. If AI->ANA, RF, anti cardiolipin, lupus anticoagulant, CXR
6. BM if suspect aplastic anemia
7/ B12 and folate
8. Renal function
9. Infection: CMV, EBV, HIV, ,malaria