10.17.18 Thrombocytopenia Flashcards

1
Q

Too few platelets

A

Thrombocytopenia

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2
Q

Too many platelets

A

Thrombocytosis

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3
Q

platelet clumping where platelet count is artificially low

A

Pseydothrombocytopenia

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4
Q

What are the categories of causes for thrombocytopenia?

A
  1. Underproduction
  2. Peripheral Destruction
  3. Splenic Sequestration
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5
Q

What are causes for underproduction?

A
  1. Marrow failure
  2. Marrow infiltration
  3. Marrow toxins
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6
Q

A process, characterized by abnormal activation of coagulation, generation of thrombin, consumption of clotting factors, destruction of platelets, and activation of fibrinolysis

A

Disseminated Intravascular Coagulation (DIC)

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7
Q

How do you diagnose DIC?

A
  1. Elevated PT
  2. Low platelets
  3. Low fibrinogen
  4. Elevated D-Dimers
  5. Schistocytes
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8
Q

How do you treat DIC

A

Treat the underlying cause

  • Sepsis
  • Burns
  • OB probs
  • Leukemia
  • Shock
  • Venom
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9
Q

A process, characterized by abnormal activation of platelets and endothelial cells, with vWF and fibrin deposition in the microvasculature, and peripheral destruction of platelets and RBC

A

Thrombotic Thrombocytopenic Purpura (TTP)

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10
Q

How do you diagnose TTP?

A
  1. MAHA
  2. Schistocytes (NEED)
  3. Low platelets (NEED)
  4. Fever
  5. Neurologic Manifestations
  6. Renal Manifestations
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11
Q

How is TTP caused?

A

Sporadic but there is an autoantibody against ADAMTS-13 which is a protease that cleaves vWF. W/o it there is an accumulation of large vWF and abnormal platelet activation

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12
Q

What drugs can induce TTP?

A

Quinine, Cyclosporine, Tacrolimus

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13
Q

There is an increased incidence of TTP with what?

A
  1. Pregnancy

2. HIV/AIDS

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14
Q

How do you treat TTP?

A

PLEX with corticosteroids
Secondary: Splenectomy, Vincristine
Relapse: Rituximab

AVOID PLATELET TRANSFUSION

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15
Q

Usually classified with TTP but has fewer neurologic sequelae and more renal manifestations

A

Hemolytic Uremic Syndrome (HUS)

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16
Q

What usually causes HUS?

A

E.Coli or Shigella –> Shiga Toxin

17
Q

This is HUS without the diarrheal prodrome

A

Atypical HUS

18
Q

How is Atypical HUS started?

A
  1. Disorder of complement regulation

2. Pregnancy/infection trigger

19
Q

What are diagnostic features of atypical HUS?

A
  1. MAHA
  2. Low platelets
  3. Renal failure
  4. Evidence of complement activation
20
Q

How do you treat atypical HUS?

A
  1. PLEX

2. Eculizumab

21
Q

What drugs cause thrombocytopenia?

A
  1. Beta-lactam antibiotics
  2. Trimethoprim-sulfamethoxazole and other sulfa drugs
  3. Quinine/Quinidine
  4. Heparin (if platelets fall on this stop immediately)
22
Q

This disorder has no diagnostic test but is suspected in patients with isolated thrombocytopenia

A

Immune/Idiopathic Thrombocytopenic Purpura (ITP)

23
Q

How do you treat ITP?

A
  1. Corticosteroids
  2. If platelet count is less that 10K use IVIg

Second line: Rituximab, Splenectomy

24
Q

When do you do platelet transfusion with

ITP
TTP
DIC
Splenic Sequestration
Hypoproduction?
A
ITP- only severe bleeding
TTP- DON'T
DIC- give to treat bleeding
Splenic sequestrations- reserve for severe bleeding
Hypoproduction- less than 10K transfuse
25
What are myeloproliferative syndromes?
1. Essential Thrombocythemia 2. Polycythemia Vera 3. CML 4. Myelofibrosis
26
What causes secondary thrombocytosis?
1. Inflammation 2. Infection 3. Bleeding 3. Iron-deficiency 4. Post-splenectomy