Haematological emergencies

Question 1

Immune thrombocytopenia purpura

Answer 1

• Primary ITP = no apparent cause
• Secondary ITP = infection
• Due to autoantibodies against platelet antigens – low platelets
• Large platelets = megakaryocytes working harder
• Treated with Glucocorticoid + IV IG’s

Question 2

Pneumonia in an immunocompromised patient

Answer 2

• Check for complications of BMT
• Viral e.g. CMV, RSV
• Bacterial e.g. Strep pneumoniae
• Fungal e.g. Pneumocystis jirovecci
• Treat immediately with broad spectrum AB

Question 3

Acquired Thrombotic Thrombocytopenic Purpura (TTP)

Answer 3

• accumulation of ultra-large vWF molecules
• Causes thrombotic microangiopathy
• Small-vessel platelet rich thrombi
• Presents with MAHA (microangiopathic haemolytic anaemia)
• Treat with plasma exchange to provide ADAMTS13

Question 4

Neutropenic sepsis

Answer 4

High risk patients:

• Haematological malignancies and those receiving intensive chemotherapy
• AML and ALL
• Recipients of autologous or allogenic stem cell transplants