CIS: Pediatric Platelet Disorders Flashcards
How are bruises with vasculitis different
- they look the same as a normal bruise
- CBC will show normal or slightly elevated platelets
Normal platelet count
150-450 thousand for a kid
Primary hemostasis impaired when count is below..
75 thousand
what is the weird thing that will cause thrombocytopenia?
cyanotic heart disease
What is the big cause of thrombocytopenia in kids
Increased platelet destruction
- Immune (HEPARIN)
- non immune (DIC, HUS, TTP, infection)… these all suck
Acute ITP
the most common cause of thrombocytopenia in children
- Isolated throbocytopenia in the absence of any obvious initiating or underlying cause
- most common cause of isolated thrombocytopenia in OTHERWISE WELL CHILDREN
- peak 2-5 y/o
Presentation of acute ITP?
- sudden onset of bruising or mucocutaneous bleeding
- OTHERWISE HEALTHY CHILD!
What can the ITP children not have?
anything besides the bleeding
- they should look fine besides the bleeding disorders
- if you have anything else, you have to think about something else
- no LAD or splenomegaly or anything like that
Why is serious bleeding requiring transfusion uncommon?
there are less platelets but they are really sticky (immature) so we don’t need as many of them to do the same job
difference between acute and chronic ITP
whether it has been going on for 6 months or not
What do we look for on a peripheral that will tell us it is not ITP?
Platelet morphology
schistocytes
+ direct coombs
-fibrin degradation products and fibrinogen measurements
Does treatment alter the course of ITP?
no
- nothing long term will help this
- short term: prednisone, IVIG, Anti-D immunoglobulin
- controversial
What can happen that sucks in ITP but it is kinda rare because of the super sticky platelets?
Intracranial Hemmorrhage
HUS and TTP
consumption of platelets resulting from endothelial cell injury and vasculitis
TTP
- far more comon in adults
- thrombocytopenia and hemolytic anemia
HUS
- far more common in children
- they get it from e coli
- hemolytic anemia
- its BAD!
Chronic ITP
> 6 months
-otherwise well
generally benign like the acute
-does not require aggressive drug therapy
-bruising and occ petechiae
-Can attend school and participate except for contact sports
-most children improve over time
What is the last resort type of thing we would do for this?
splenectomy
-the spleen is what keeps destroying the cells
Where will kids typically have bruises if it isn’t abuse
on the knees and front of tibia
-they keep running into things
Spontaneous bleeding happens when the platelet count is below….
50,000
severe bleeding
20,000
life threatening hemorrhage
10,000
from normal to life threatening hemorrage (numbers)
150, 75, 50, 20, 10
if there’s any changes in any other cell lines, what do we have to worry about?
leukemias!!!
