Thrombocytopenia

Question 1

thrombocytopenia

Answer 1

platelet counts less than 150,000

• common cause of abnormal bleeding
• decreased production of platelets or increased destruction of platelets
• sequestration

Question 2

types of thrombocytopenia

Answer 2

ITP
NATP
TTP
TAR

Question 3

ITP

Answer 3

immune thrombocytopenic purpura

Question 4

PP of ITP

Answer 4

antibody that binds to plateltet membrane

-common in children after a viral infxn

Question 5

CF of ITP

Answer 5

1-4 wks post viral illness
-abrupt onset of petechia, brusing, epistaxis

+/- hemorrhagic bullae on skin and mucus membrane

• no splenomegaly
• heparing is the drug tha tmost commonly cuases ITP like rx in hospitalized pts (HIT)

can be caused by SLE or CLl

Question 6

drugs that may cause ITP

Answer 6

sulfonamides, quinine, thiazides, cimetidine, gold,

Question 7

lab eval of ITP

Answer 7

severe thrombocytopenis, smear that shows megathrombocytes, coag studes are normal

Question 8

dx of ITP

Answer 8

PE

Question 9

tx of ITP

Answer 9

• benign self-limiting

- if indicated: steroids, IVIG, anti-D immunoglobulin (chronic ITP)

Question 10

what should you avoid in ITP

Answer 10

antiplatelet meds (nsaid)

Question 11

NATP

Answer 11

neonatal alloimmune thrombocytopenic purpura

Question 12

PP of NATP

Answer 12

• Occurs as the result of sensitization of mother to antigens present on fetal platelets
  o Antibodies cross the placenta & attack fetal platelets
  o Infant at risk for intracranial hemorrhage in utero

Question 13

lab dx of NATP

Answer 13

fetal scalp sampling or percutaneous umbilical blood smpaling to measure fetal platelet count

Question 14

tx of NATP

Answer 14

c-section, infants may need steroids after birth

Question 15

TTP

Answer 15

• congenital or acquired def of enzyme needed to cleave von willebrand factor
• congenital is RARE and often fatal
• women, HIV +

Question 16

what can preciptate TTP?

Answer 16

estrogen use, preg, drugs (quinidine and ticlopindine)

Question 17

CF of TTP

Answer 17

• jaundiced or pale
• purpura, petechiae, pallor, abdom pain, microangiopathic hemolytic anemia, fever
• may have renal dz
• +/- pancreatitis, recurrent episodes are common

Question 18

Lab evaluation of TT

Answer 18

o Severe thrombocytopenia
o Typically have schistocytes in circulation (red cell fragmentation)
o RBC destruction
o Negative Coombs’ test
o Markedly elevated LDH. Increased indirect bilirubin
o Coagulation tests are normal

Question 19

tx of TTP

Answer 19

plasma exchange, prednisone and antiplatelt

Question 20

HUS

Answer 20

hemolytic uremia syndrome

Question 21

HUS?

Answer 21

similar to TTP but found primarly in kids (younger than 10, particularly after infx w. e coli, shigella, or salmonella

Question 22

what can precipitate HUS in adluts?

Answer 22

preg and estrogen use

Question 23

lab values of HUS?

Answer 23

similar to TTP, but thrombocytopenia is less severe

Question 24

tx of HUS

Answer 24

kids- conservative, fluids/ electorlyte balance

adults -plasmapheresis

Question 25

TAR

Answer 25

Thrombocytopenia w. absent radii syndrome

Question 26

TAR?

Answer 26

congenital megakaryocytic hypoplasia, autosomal recessive ** associated w/ orthopedic abnormalities

Question 27

CF of TAR

Answer 27

**uppper extremities (thumbs are present) * no radii is pathognomonic - thrombocytopenia resolves over time (usually by 1 year)

Question 28

tx of TAR

Answer 28

freqent platelet transfusion up to age 1 yr

Question 29

DIC

Answer 29

disseminated intravasuclar coagulation

Question 30

DIC?

Answer 30

severe illness that laters the homeostasis btw hemorrhage and thrombosis, so there is activation of both coagulation and fibrinolysis

Question 31

what conditions are associated w/ DIC

Answer 31

spesis, burns , tissue injurt, obstetric complications, truama, ashyxia, malignancy, cirrhosis, sever transfusion rxn

Question 32

CF of DIC

Answer 32

- Generalized hemorrhage in patients with severe underlying systemic illnesses - Diffuse bleeding diathesis, GI and pulmonary bleeding, hematuria - Thrombotic lesions affect the extremities, skin, kidneys, and brain - Ischemic and hemorrhage strokes can occur

Question 33

dx of DIC

Answer 33

 skin and mucous membrane bleeding (particularly at puncture/wound sites) and shock are more common. Thrombosis (commonly digital ischemia and gangrene) less often predominates - Thrombocytopenia, prolonged PT and PTT, elevated D-dimers (most sensitive) and fibrin, decreased fibrinogen and factor V and VIII levels, peripheral smear shows schistocytes. Also microangiopathic hemolytic anemia

Question 34

tx of DIC

Answer 34

- Supportive treatment, correction of underlying disorders PROMPTLY and AGGRESSIVELY - Component blood transfusions are important, particularly the replacement of fibrinogen through the administration of cryoprecipitate. The role of heparin is controversial `