Platelet Disorders

Question 1

What is immune thrombocytopenia Purpura?

Answer 1

Autoimmune destruction of platelets

Question 2

What is primary ITP?

Answer 2

Often seen post-viral infection, self-limiting

Question 3

What can cause secondary ITP?

Answer 3

Malignancies, HIV

Question 4

What is Purpura?

Answer 4

Bruising and purple/red rash

Question 5

How does ITP present?

Answer 5

Purpura, epistaxis, menorrhagia, prolonged bleeding from the gums, severe headache, vomiting, fatigue

Question 6

What investigations would you do for ITP?

Answer 6

FBC, bone marrow biopsy, platelet autoantibodies

Question 7

What would an FBC?

Answer 7

Thrombocytoenia

Question 8

How do manage ITP?

Answer 8

Prednisolone, IV IgG, Platelet transfusions, Oral azathioprine

Question 9

What does oral azathioprine do?

Answer 9

Immunosuppresses

Question 10

What is thrombotic thrombocytopenic purpura?

Answer 10

Deficiency of vWF cleaving protein

Question 11

What is TTP associated with?

Answer 11

HIV, cancer, SLE

Question 12

How does TTP present?

Answer 12

Flu-like symptoms, purpura, epistaxis, easy bruising, menorrhagia, haemoptysis, headache, abdominal pain, GI bleeding, chest pain

Question 13

What would you see on a blood smear in TTP?

Answer 13

Fragmented erythrocytes

Question 14

What U&E results would you expect in TTP?

Answer 14

Raised creatinine

Question 15

What blood results would you expect in TTP?

Answer 15

Raised bilirubin, raised reticulocyte count

Question 16

What would you expect on urinalysis in TTP?

Answer 16

Proteinuria, haematuria

Question 17

How do you manage TTP?

Answer 17

IV plasma exchange, IV methylprednisolone, rituximab, folic acid

Question 18

What is DIC?

Answer 18

Systemic activation of blood coagulation

Question 19

What is DIC associated with?

Answer 19

Previous sepsis, malignancies, crush syndrome, transplant rejection, drugs

Question 20

How does DIC present?

Answer 20

Large bruises, spontaneous bleeding at venepuncture sites or after minor trauma, epistaxis, GI bleeds, confusion and shock, fever, ARDS, purpura, gangrene

Question 21

What would you see on an FBC in DIC?

Answer 21

Severe thrombocytopenia

Question 22

What blood results would you expect?

Answer 22

Prolonged PT time, prolonged activated partial thromboplastin time, low fibrinogen levels

Question 23

How would you manage DIC?

Answer 23

Treat underlying cause, platelet transfusion if present with bleeding, red cell transfusion in those bleeding, FFP to replace coagulation factors