10 Hematology 2 Flashcards
Acquired platelet dysfunction
D/t Aspirin, NSAIDs, systemic disorders (HIV, hep c)
Causes of thrombocytopenia
Failure of production, increase sequestration/destruction/dilution, quinine, drugs, liver dz, DIC, pregnancy, ITP, HIV, blood transfusion, ARDS, gram neg species
Hereditary intrinsic platelet disorder
Rare autosomal recessive
Glanzmann’s thrombasthenia and Bernard-Soulier syndrome
Dx: platelet aggreg test
Idiopathic thrombocytopenia purpura
Autoimmune, increased platelet destruction. Children (acute and self limited) and >60 yrs (chronic)
Causes: HIV, hep c, CMV, drugs, idiopathic
Petechaie, mucosal bleeding DDx
Vasculitis purpura, hemophilia, thrombocytopenia
Thrombotic thrombocytopenic purpura
Can’t break down vWF…increase platelet aggregation
Classic pentad: RBC fragmentation, thrombocytopenia, fever, transient hemolytic deficits, kidney failure
Von Willebrands disease
Autosomal dominant. Mild skin/mucosal bleeding, easy bruising, menorrhagia
Suspect if family hx
Definitive dx: plasma vwf antigen, vwf activity, factor 8
Acquired causes of risk to thrombosis
Heparin, anti-phospholipid antibodies, hyperhomocystinemia, stasis, CHF, pregnancy, obesity, trauma, sepsis, estrogen/oral contraceptives, smoking
Factor V Leiden mutation
5% prevalence in Europeans. Present in 20-60% of pts w spontaneous thrombosis
Protein C / S deficiency
Venous and/or arterial embolism, warfarin induced skin necrosis
May be acquired, w liver dz, chemo, DIC, warfarin
Hyperhomocystinemia
Genetic cause of risk for thromboembolism
Disseminated intravascular coagulation
Excess clotting, excess bleeding.
D/t abortion, retained dead fetus, infection, malignancy, shock/burns, severe diseases
Persistent bleeding, ecchymoses, GI bleeding
Dx: D-dimer
Hemophilias
Commonly factor VIII (A) or IX (B) deficient [<5% clotting factors]
Serious hemorrhage from minor injuries, hemarthrosis diagnostic, hematuria, bruising
Amyloidosis
Deposition of protein in vessels, increasing vascular fragility. Perioribital purpura or purpuric rash
Cryoglobulinemia
Causes small vessel vasculitis and purpura
Hypergammaglobulinemic purpura
Assoc w autoimmune, SLE; vascular purpura esp lower legs
Hyperviscosity syndrome
Very high IgM, seen in waldentroms macroglobulinemia
Hereditary hemorrhagic telangiectasia
Arteriovenous malformations. On face, lips, oral/nasal mucosa, phalanges
Purpura simplex
Common! Easy bruising dt vascular fragility
D/t deficiency in flavonoids?
Senile purpura
Dark ecchymoses, forearms and hands. Skin thin and atrophic
Idiopathic hypereosinophilic syndrome
Eosinophils infiltrate organs and destroy stuff.
Dx: CBC w peripheral smear, B12 levels, IgG, IgE. EKG.
Langerhan’s Cell Histiocytosis
Proliferative dendritic cells invade 1+organs. Eosinophilic granuloma (bone pain, swelling), Hand-Schuller-Christian dz, Letterer-Siwe dz
Dx: biopsy–Langerhan’s cells, radiograph–sharply demarcated bome lesions
Essential thrombocythemia
Increased platelet count, megakaryocyte hyperplasia, hemorrhagic/thrombotic tendency
Sxs: weakness, HA, parasthesias of hands/feet, mild bleeding, digital ischemia (raynauds) splenomegaly, erythromelalgia, thrombosis
Erythromelalgia
Erythematous burning hands (after exposed to warm)