CIS-Heme/Lymph/Oncology Flashcards
non-blanchable, hemorrhagic skin lesions that result from leakage of RBCs into skin, can be palpable or non-palpable
purpura
characterize purpura in thrombocytopenic purpuric disorders
non-palpable
which demographic is more likely to experience intussusception in HSP? what about renal involvement, including end-stage renal disease?
Intussusception-children, much less common in adults
renal disease-Adults»_space;children
Characteristic tetrad for HSP?
MANDATORY: Palpable purpura w/o thrombocytopenia and coagulopathy PLUS, one or more of the following: -acute arthralgia and/or arthritis -acute abdominal pain -renal disease -IgA deposition on biopsy
considerations for dx of HSP?
- may follow strep infx (sore throat)
- present with generalized arthralgias/myalgias, rash, palpable purport (esp on LE and buttocks), abdominal pain, and renal insufficiency
HSP is what type of Ig-mediated vascultis?
IgA
what else to consider in DDx for arthritis and arthalgia in this case?
- Autoimmune: SLE, Juvenile idiopathic arthritis
- Rheumatic fever –> evidence of recent group A beta-hemolytic strep infx, consider the JONES criteria
- Septic and toxic synovitis (transient synovitis) –> only involves 1 or 2 joints, HSP is a polyarthritis
- Reactive arthritis
a significant proportion of cases of HSP are triggered by what infx?
streptococcal
how do you manage pts presenting with HSP?
- vast majority recover spontaneously and care is primarily supportive
- Assess renal status, overall fluid/electrolytes. Steroids can be used but only when absolutely needed
- pain mgm –> NSAIDS, dep on renal status
- anti-emetics
- PPI to minimize gastritis/PUD from NSAID or steroids
- Acute abdominal series or US to screen for intussuception
in management of HSP, what should you do empirically until labs return?
-**IV hydration –> IV fluid rate and saline/D5/LR is empiric until labs return. goal is to initiate rehydration and monitor
this lab is elevated in 50-70% of HSP pts and higher levels associated with renal involvement
Serum IgA levels
When doing routine blood tests such as CBC, CMP, and UA in HSP pts, what lab components are necessary to confirm when clinical features do not allow conclusive distinction of HSP (IgAV) from other diseases that present with purport d/t thrombocytopenia or coagulopathy?
normal platelet count and coag studies (PT time)
levels of complement in HSP?
typically normal
what does light microscopy from a skin biopsy sample show of the BVs of superficial dermis in an HSP pt?
leukocytoclastic vasculitis in postcapillary venues with IgA deposition that is PATHOGNOMONIC OF HSP
what does IF microscopy show from a kidney biopsy of a HSP pt?
IgA deposition in mesangium that is identical to that in IgA nephropathy
__ is an indicator of long-term kidney disease (CKD) in HSP
Proteinuria
for a child w/ HSP who you suspect intussusception, what imaging should you consider?
US rather than contrast enemas should be initial screening test
location/type of intussusception in more than 1/2 cases in pts with HSP?
ileoileal intussusception
imaging modality to distinguish scrotal pain caused by HSP from testicular torsion?
doppler flow studies and/or radionuclide scans
OMM in acute setting?
contraindicated d/t vasculitis
OMM once pt recovers?
- viscerosomatics of kidney (T10-L1)
- viscerosomatics for upper and lower GI (upper GI=T5-9, lower=T10-L2
- Lymphatics
