ITP Flashcards
What are causes of thrombocytopenia?
ITP SLE Thrombotic thrombocytopenic purpura DIC Fanconi anaemia Aplastic anaemia HSP
What are clinical features of thrombocytopenia?
Bruising
Petechiae
Purpura
Mucosal bleeding - epistaxis, bleeding from gums
What causes immune thrombocytopenic purpura?
Destruction of circulating platelets by antiplatelet IgG autoantibodies
What change may be seen in the bone marrow in ITP?
Compensatory increase of megakaryocytes
What are clinical features of ITP
2y-10y
Onset 1w -2w after a viral infection (e.g.URTI)
Petechiae, purpura and/or superficial bruising
Epistaxis and other mucosal bleeding
Profuse bleeding is uncommon
How is ITP diagnosed?
Diagnosis of exclusion Examine bone marrow to exclude acute leukaemia or aplastic anaemia if atypical clinical features: Anaemia Neutropenia Hepatosplenomegaly Lymphadenopathy
What is advice in ITP?
Acute, benign and self limiting condition
Spontaneous remittance within 6-8 weeks
Avoid trauma and contact sports while platelet count is low
Continue to attend school
What treatment in ITP
ost do not need therapy
Treatment given if evidence of major bleeding (intracranial, GI) or persistent minor bleeding that affects daily life such as epistaxis or menstrual bleeding
Oral prednisolon
Intravenous anti-D
or IV immunoglobulins
Perform bone mark examination if steroids are used as they may temporarily mask diagnosis of ALL
What is chronic ITP?
Platelet count remains low 6 months after diangosis
How is chronic ITP managed?
Supportive
Rituximab and monoclonal antibodies against B lymphocytes
Splenectomy reserved for children who fail drug therapy
- Increases risk of infection
- Lifelong antibiotic prophylaxis required
- Regular screening for SLE as thrombocytopenia may predate development of autoantibodies
What is DIC? Causes? Presentation
Coagulation pathway acitvation leading to diffuse fibrin deposition in microvasculature and consumption of coagulation factors and platelets
causes: Sever sepsis Shock Trauma Burns
Presentation:
Bruising
Purpura
Haemorrhage
When should DIC be suspected?
Thrombocytopenia Prolonged PT (extrinsic pathway) Prolonged APTT (intrinsic pathway) Low fibrinogen Raised fibrinogen degradation products D-dimers
Reduced protein C, protein C and antithrombin-3
What is Mx of DIC?
Treat cause
Supportive care with FFP to replace clotting factors, cryoprecipitate, platelets
What are antibodies against in ITP
Glycoprotein IIb/IIIa
