Onc & Haematology Flashcards
what is the natural history of ITP? What is a uncommon but serious complication?
Idiopathic Thrombocytopenia Purpura
Often follows viral illness in children with abrupt onset. history of days- weeks. usually aged 2-10. Due to autoimmune destruction (IgG mediated) of platelet cells. Isolated thrombocytopenia resulting in:
petechiae, bruising, purpura, sometimes epistaxis, excessive menstrual bleeding
The risk of bleeding depends on the level of platelets
4/100,000 affected
Intracranial bleed therefore discourage contact sports etc.
How should a parent be counselled if child has ITP?
Avoid contact sports, rough play, supervision during play time. Will bruise more easily.
avoid antiplatelet therapies e.g. NSAIDS + Aspirin
What is low platelets called? And what level of platelets indicates low levels? What is the ddx?
Less than 150 x 10^9
Thrombocytopenia
ITP, congenital thrombocytopenic syndrome, ALL, haemolytic uraemic syndrome, SLE, aplastic anaemia, CHD, disseminated intravascular coagulation (DIC) - sepsis is common acute cause - diffuse fibrin deposition + consumption of clotting factors + platelets.
How is ITP managed?
80% self limiting, most can be followed up in OP/ GP setting to observe platelets returning to normal levels.
If major bleeding, first line is corticosteroids e.g. oral prednisolone 1-2mg/kg/day. second line is IV Ig. For intractable chronic ITP, rituximab or other immunosuppressant +/- splenectomy. If acute life-threaten bleed: platelet transfusion, oral pred, IV Ig + transexamic acid (stabilise clots that have already formed by inhibiting fibrinolysis)
what are the common PC of ALL?
gen- malaise, anorexia
BM- Anaemia- Pallor, lethargy
- Neutropenia- infection
- thrombocytopenia - bruising, petechiae, nose bleeds
- bone pain
reticuloendothelial infiltration (connective tissue where high rates of phages collect in these areas)- hepatosplenomegaly, Lymphadenopathy, mediastinal obstruction (rare)
If relapse certain organ specific infiltrations:
- Testes- enlargement
- CNS- headaches, vomit, nerve palsies
