Bleeding Disorders Flashcards
Thrombocytopenia- description
<50 K plt
Nl= 150-460k
Thrombocytopenia- cause
Spontaneous bleeding - <20K
Found incidentally after a CBC
- Decreased plt production
- BM suppression/failur - meds, chemo, aplastic anemia
- BM destruction - lysis, Ca - Inc plt destruction - DIC, TTP, HELLP, ITP, HIT, HUS
- Other - sepsis, blood loss
Thrombocytopenia- s/s
Capillary rupture:
- petechia <3mm
- purpura- 3-10mm
- ecchymosis >10
Long bleeding after trauma- easy bruising
Mild bleeding- gingival and nasal
Thrombocytopenia- labs & imaging
CBC- thrombocytopenia
- bleeding time long
Thrombocytopenia- treatment
Address underlying causes
- remove meds
- BM failure or destruction? Get BMA
Idiopathic thrombocytopenic purpura (ITP)- description
Autoimmune disease characterized by abnormal dec in number of platelets
- IgG antibody binds to platelets and “tags” them for destruction by spleen
Idiopathic thrombocytopenic purpura (ITP)- cause
Children w viral infections- self limiting
Worse in adults- chronic
Idiopathic thrombocytopenic purpura (ITP)- s/s
Come in for non-blanching rash- petechia, purpura
Idiopathic thrombocytopenic purpura (ITP)- labs & imaging
Diagnosis:
- Plt <50K
- must rule out other causes
- serum antiplatelet antibody assay and antiplatelet glycoprotein antibody - poor sensitivity, but may be helpful
Bleeding time - long
Pt, aPPT, Firbrinogen, BM - nl
Idiopathic thrombocytopenic purpura (ITP)- treatment
Children- self limiting- monitor Adults: - 20k w out bleeding plt- no tx needed - should recover in 3w - <20k or bleeding plt: prednisone, IVIG,, plt transfusions, splenectomy
Thrombotic thrombocytopenic purpura (TTP)- description
Autoimmune process- extensive microscopic intravascular clotting—> plt clump —> thrombocytopenia—> easy bleeding
Shearing of RBCs —> lysis
Thrombotic thrombocytopenic purpura (TTP)- cause
Enzyme defect or 2nd to other process
Drugs - quinine, plt aggregation inhibitors, immunosuppressants Bact infection Pregnancy Other autoimmune dis BMT
F>M
Adult
Thrombotic thrombocytopenic purpura (TTP)- s/s
PENTAD:
- fever
- thrombocytopenic purpura
- microangiopathic hemolytic anemia
- neurological symptoms- sz, TIA, AMS
- renal failure
Thrombotic thrombocytopenic purpura (TTP)- labs & imaging
Plt <50K Anemia Un conjugated hyperbilirubinemia LDH- inc Renal failure Urine- hematuria, proteinuria Smear- RBC fragments
Thrombotic thrombocytopenic purpura (TTP)- treatment
Emergent- Admit
- corticosteroids, pRBCs plasmapheresis, ASA, splenectomy
Avoid- plt transfusion unless catastrophic bleeding
Hemolytic uremic syndrome- description
Occurs after a gastrointestinal infection- ecoli, shigella, salmonella
Bacterial toxins damage vascular endothelium —> thrombus formation —> thrombocytopenia
Hemolytic uremic syndrome- cause
Toxins- attack kidneys —> failure
Thrombi cause shearing of RBCs —> hemolytic anemia
Children- esp w renal failure and diarrhea
Hemolytic uremic syndrome- s/s
TRIAD
- thrombocytopenia
- renal failure
- hemolytic anemia
Hemolytic uremic syndrome- labs & imaging
Plt <50K Anemia Un conjugated hyperbilirubinemia LDH elevated Evidence of renal failure Urine- hematuria and proteinuria Smear- fragmented RBCs
Hemolytic uremic syndrome- treatment
Children- self limiting
- admit for observation and IVF
- monitor renal function
Adults- same as TTP
-ADMIT- corticosteroids, pRBC’s, plasmapharesis, ASA, splenectomy
Avoid abx- inc bacterial lysis w releasing more toxins
Hemolysis elevated liver enzymes and low plt (HELLP)- description
Complication of pregnancy- occur anytime during last trimester to weeks after postpartum
- combo w preeclampsia or eclampsia
Hemolysis elevated liver enzymes and low plt (HELLP)- cause
Unknown- but halts after delivery
Hemolysis elevated liver enzymes and low plt (HELLP)- s/s
Fatigue NV HA Blurry vision Epistaxis RUQ abdominal pain- liver
Hemolysis elevated liver enzymes and low plt (HELLP)- labs & imaging
Thrombocytopenia
Anemia- low H/H, hyperbilirubinemia, inc LDH
LFTs- inc
Hemolysis elevated liver enzymes and low plt (HELLP)- treatment
Delivery
Hemolysis elevated liver enzymes and low plt (HELLP)- risks
Mother- 1% mortality risk- may develop DIC
Baby- placenta rupture, premature
Disseminated intravascular coagulation (DIC)- description
Acquired bleeding disorder
Event that accompanies dieases - infect, trauma, cancer, pregnancy
Alternation in blood blotting mechanism - abnormal acceleration of coag cascade —> thrombosis, depletion of clotting factors, hemorrahge occurs simultaneously
Disseminated intravascular coagulation (DIC)- s/s
Bleeding- multiple sites Manifested by ecchymosis, petechiae, purpura Cool/molted extremities Dyspnea Chest pain Hematuria
Disseminated intravascular coagulation (DIC)- labs & imaging
Coag panel is off
Disseminated intravascular coagulation (DIC)- treatment
Supportive care- treat underlying disorder
Transfuse blood product as needed- PRBCs- platelet <20k- FFP
Heparin- maybe?
Heparin induced thrombocytopenia (HIT)- description
Thrombocytopenia after admin of heparin
Heparin —> fine for 5 days —> formation of abnormal antibodies —> activate platelet —> clots formed —> platelet count dec —> fewer platelets= more bleeding
Heparin induced thrombocytopenia (HIT)- s/s
Rarely symptomatic- thrombosis
Heparin induced thrombocytopenia (HIT)- labs & imaging
Plt- dec
Heparin induced thrombocytopenia (HIT)- treatment
Stop heparin! - replace another anticoag- NOT WARFARIN Eval pt Rare- plt tranfusion Avoid heparin indef HOSP!!
