Lecture 4: Thrombocytopenia in Pediatric Patients Flashcards

1
Q

At which platelet counts is spontaneous bleeding, clinically significant bleeding, and life threatening hemorrhage possible?

A
  • Spontaneous = <50 x 103/uL
  • Clinically significant = <20 x 103/uL***
  • Life threatening = <10 x 103/uL
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2
Q

What are the 4 most common conditions associated with fetal/neonatal thrombocytopenia?

A
  • Alloimmune thrombocytopenia
  • Congenital infection (i.e., CMV, toxoplasma, rubella, HIV)
  • Aneuploidy (i.e., triomy 18, 13, or 21 or triploidy)
  • Autoimmune conditions (i.e., ITP, SLE)
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3
Q

Kasabach-Merrit syndrome can be associated with early-onset neonatal (<72 hrs) thrombocytopenia and what other finding?

A

Large hemangiomas

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4
Q

Late onset neonatal (>72 hr) thrombocytopenia is almost always due to what?

A

Late-onset sepsis

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5
Q

Which disorder in children causing thrombocytopenia is a primary platelet consumption syndrome?

A

Idiopathic thrombocytopenia purpura

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6
Q

Which 2 disorders causing thrombocytopenia in children are due to combined platelet and fbrinogen consumption syndromes?

A
  • DIC
  • Kasabach-Merritt syndrome
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7
Q

Ecchymosis/bruising may be seen with platelet disorders in childre, you should worry if what 3 things are seen?

A
  • Multiple
  • Atypical distribution
  • Bruising inconsistent with activity or force of injury
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8
Q

A young male presenting with eczema, recurrent infections, and small platelets should make you think what?

A

Wiscott-Aldrich Syndrome

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9
Q

How does acute idiopathic thrombocytopenic purpura (ITP) most commonly manifest in a child and what is the platelet level/morphology?

A
  • Sudden onset of petechiae and bruising in otherwise well child; most often following a viral infection
  • Platelet count usually <20x103/uL —> platelets presents are usually large
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10
Q

Which 3 treatments are most commonly used for acute ITP (usually only when severe or life-threatening hemorrhage)?

A
  • IVIG
  • Prednisone (or other corticosteroid)
  • Anti-D immunoglobulin (only in Rh (-) children)
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11
Q

After 12 months of ongoing ITP (chronic) in a child what other disorders should you evaluate for?

A
  • Autoimmune diseases like SLE, chronic infections like HIV
  • Non-immune causes like platelet type vWF, x-linked thrombocytopenia
  • H. pylori infection***
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12
Q

Hemolytic-uremic syndrome (HUS) is due to what?

A

Vascular injury (especially kidneys and colonic mucosa) from toxins from E.coli O157:H7 causing consumption of platelets

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13
Q

What is the only cell line involved in ITP?

A

Platelets

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