Haematology

Question 1

What is ITP

Answer 1

Immune thropcytopenic purpura

Autoimmune (antibody) destruction of platelets often occuring 2-3 weeks after viral infection - URTI commonly

Question 2

DDX for ITP

Answer 2

Aplastic anaemia
Leukaemia
Von Willibrands disorder
Meningococcal septicaemia
Non-accidental injury

Question 3

Investigations for ITP

Answer 3

FBC and platelets
ANA test may indicate chronicity

Coombs teest for platelet antibodies

Question 4

Presentation of ITP

Answer 4

May be asymptomatic
often develop purpura and bruising over 48hrs
occasionally bleeding - nose, and GI
Petechiae (<3mm) purpura (>3mm)

Question 5

Management of ITP

Answer 5

Conservative - may resolve in 2-3 weeks
Avoid NSAIDs and contact/physical sport
if severe IVIg + steroids may be required
Splenectomy is last resort

Question 6

What is Henoch-Schonlien purpura?

Answer 6

Multi-system involvement IGA vasculitis
M/C in 3-10 years olds
Hx of recent URTI

Question 7

Possible presentations of HSP

Answer 7

Arthritis
Abdominal Pain - risk of intussusception
Orchitis
Nephritis - Mesangial IgA nephropathy

Question 8

Ix of HSP

Answer 8

Dx may be clinical with palpable purpura on extensor surfaces

FBC, U&Es
Urine dip for haematuria 
BP - elevated
Skin Biopsy - ONLY IF UNCERTAIN 
if renal problems suspected - USS

Question 9

Mx of HSP

Answer 9

Symptomatic - check on hypertension and blood cultures is child is unwell
75% will resolve spontaneously, minority will develop long term renal complications (?transplant)