"...Penias"

Question 1

What is thrombocytopenia?

Answer 1

Platelet count <150
From:
↓Production
↑Consumption
↑Destruction
Pooling in an enlarged spleen

Question 2

What are the causes of thrombocytopenia?

Answer 2

• Congenital: Fanconi’s, Leukaemia, Wiskott-Aldrich, Bernard-Soulier
• ↓Production: EBV, Rubella, Mumps, HIV, Aplastic anaemia, Ca, OH-, Chemo, ALL
• ↓Survival: ITP, SLE, RA, Sarcoid, DIC, HUS, HELLP, immune thrombocytopenia- SCREEN FOR HIV!
• Platelet dysfunction: vWD, CKD, Myeloma
• ↑Consumption: DIC, TTP, massive haemorrhage

Question 3

How does thrombocytopenia present?

Answer 3

Spont bruising
Epistaxis
Bleeding gums
Petechiae/Purpura/Ecchymoses
Bleeding w/Aspirin & NSAIDs

Question 4

What are the red flags Sx for severe thrombocytopenia?

Answer 4

Haemoptysis
Haematemesis
Haematuria
Haematochezia
Melaena

Question 5

How is thrombocytopenia investigated?

Answer 5

Bloods: FBC & Clotting studies
Blood Smear
>60yo = BM Exam

Question 6

How is thrombocytopenia managed?

Answer 6

Conservative: Monitor every few months
Admission: Platelet transfusion

Question 7

What are the indications for hospital admission with thrombocytopenia?

Answer 7

Platelets <20
Bleeding or bruising
Abnormal examination
Concomitant anaemia/neutropenia

Question 8

What is pancytopenia?

Answer 8

LOW RBC
LOW Platelets <150
LOW WBC

Question 9

What are the causes of pancytopenia?

Answer 9

Deficiency: Aplastic anaemia, Folate/B12 def
Infection: HBV, EBV, Parvovirus
Drugs: Trimethoprim, Carbimazole, Carbamazepine, Chloramphenicol, Tolbutamide
Cancer: Lymphoma, Myeloma

Question 10

What is the most likely diagnosis for someone with BM failure & pancytopenia?

Answer 10

Myeloma

Question 11

How does pancytopenia present?

Answer 11

Symptoms of:
-Anaemia: Dyspnoea, fatigue, pale, tachy
-Neutropenia: Infections
-Thrombo: Epistaxis, bruising, bleeding
Hepatosplenomegaly & lymphadenopathy

Question 12

What is the most likely diagnosis for someone with Hepatosplenomegaly, lymphadenopathy & pancytopenia?

Answer 12

Leukaemia

Question 13

What cause of thrombocytopenia is most likely in someone who present with bleeding gums?

Answer 13

Von Willebrand Disease

Question 14

How is pancytopenia investigated?

Answer 14

FBC

Question 15

How is pancytopenia managed?

Answer 15

Transfusion: RBC & Platelets

+/- BM Transplant

Question 16

What is the difference between neutropenia & febrile neutropenia?

Answer 16

N = Absolute neutrophil count of <1.0×109/L

Febrile N = > 38oC + absolute neutrophil count of <1.0×109/L

Question 17

What are the causes of neutropenia?

Answer 17

• Congenital
• BM Malignancy
• Aplastic anaemia, B12/Folate
• Drugs: Phenytoin, Chloramphenicol, OH-, RT, Chemo
• Infections: EBV, Hep B/C, HIV, CMV, Typhoid
• ↑Turnover: Malaria, Hypersplenism, Felty’s

Question 18

Which patients are high risk for febrile neutropenia?

Answer 18

Active malignancy
Active Chemo
HIV
Immunosuppression: Azathioprine, Steroids

Question 19

How is febrile neutropenia investigated?

Answer 19

Blood Cultures: x2 from peripheral vein AND any indwelling venous catheters
Bloods: FBC, U&E, LFT, CRP, ESR, Coag
Imaging: CXR

Question 20

How is febrile neutropenia treated?

Answer 20

Abx WITHIN 1HOUR!
Abx: IV Tazocin (assess oral switch after 48hours)
IV Fluids

Question 21

Which patients are contraindicated for oral antibiotics in suspected febrile neutropenia?

Answer 21

Pneumonia
Acute leukaemia
Evidence of organ failure
Indwelling venous catheter
Severe soft tissue infection

Question 22

How does bone marrow failure present?

Answer 22

Anaemia
Neutropenia
Thrombocytopenia