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Heme Lymph Exam II > Platelet Disorders > Flashcards

Platelet Disorders Flashcards

1
Q

Most common cause of bleeding

A

Thrombocytopenia

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2
Q

T/F: pts with thrombocytosis are usually asymptomatic

A

True

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3
Q

Pts with _____ _____ (a myeloproliferative d/o) may have bleeding, thrombosis, or both as a component of their presentation

A

Essential thrombocythemia

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4
Q

Complication due to vasomotor changes that occurs with essential thrombocythemia characterized by burning pain and responds to aspirin therapy

A

Erythromelalgia

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5
Q

4 drugs/drug classes that are known for lowering the platelet count

A

Loop diuretics
H2 blockers
Digoxin
Abx

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6
Q

process involved in pseudothrombocytopenia and the characteristic finding on peripheral smear

A

Pseudothrombocytopenia is an in vitro sampling error resulting from CBC drawn in EDTA tube

Characteristic finding is in vitro clumping

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7
Q

What is the plan for additional evaluation of a measured platelet count in pseudothrombocytopenia?

A

Repeat CBC in heparin or citrate tube

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8
Q

4 disorders that affect platelet production

A

B12 or folate deficiency — associated with pancytopenia, macrocytosis, macro-ovalocytes, hypersegmented neutrophils, and possible neuro sxs

Bone marrow disorder (acute leukemia, aplastic anemia, myelodysplastic syndrome)

Toxin or drug-mediated bone marrow injury

Infection (HIV, Hep B and C, EBV, rubella, DIC, other infections)

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9
Q

Describe workup for pt with thrombocytopenia in which platelet count is <100,000/microliter

A

Exclude pseudothrombocytopenia on PB smear

Abnormal blood smear or abnormality of WBC or RBC suggests bone marrow d/o

Large spleen suggests hypersplenism

Immune mediated; primary or secondary ITP; drug-induced

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10
Q

Describe workup for pt with thrombocytopenia in which platelet count is >100,000/microliter

A

Exclude pseudothrombocytopenia on PB smear

Follow CBC — if stable, just continue to observe

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11
Q

Management for thrombocytopenia in aplastic anemia

A

Tx aplastic anemia w/ allogeneic HCT in pts <40 that are otherwise healthy with HLA-compatible sibling

Pts not eligible for above can get immunosuppressives with antithymocyte globulin and cyclosporin

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12
Q

Tx for thrombocytopenia due to marrow invasion

A

Treat if symptomatic

Supportive care = red cell and/or platelet transfusion

Low intensity therapy = hematopoietic growth factors, immunosuppressives, lenalidomide

High intensity therapy = chemo with allogeneic HCT

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13
Q

How does hypersplenism lead to platelet sequestration

A

Cytopenias result from increased destruction of cell elements secondary to reduced flow of blood through enlarged and congested cords or to immune-mediated mechanisms

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14
Q

How does ITP result in platelet destruction?

A

Autoantibodies — arise in 3 settings — response to a drug (quinine), association with a disease (HIV, SLE, H.pylori, etc), or idiopathic

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15
Q

Consumptive thrombocytopenia and microangiopathic hemolysis from platelet thrombi that form throughout microvasculature

Presents with fever, AKI, and fluctuating neuro signs

A

TTP-HUS

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16
Q

Lab findings in TTP-HUS

A

Prominent schistocytes, decreased haptoglobin, elevated LDH, check for ADAMSTS13

17
Q

Management of ITP

A

Glucocorticoids +IVIG

[consider immunosuppressives — anti-Rho Ig, rituximab]

18
Q

HIT management

A

Discontinue heparin, replace with rapidly acting AC (lepirudin, argabotran)

19
Q

TTP/HUS management

A

Plasma exchange transfusion and glucocorticoids; can consider rituximab

[in young pts with HUS d/t O157H7 just do supportive care — better px]

20
Q

Disorders that result in secondary thrombocytosis

A 
Acute blood loss
Iron deficiency
Asplenic states
Recovery from thrombocytopenia
Malignancy
Chronic inflamm/infectious dz
Acute inflamm/infectious dz
Response to exercise
Response to drugs (vincristine, epinephrine, ATRA, cytokines, growth factors)
21
Q

Meds that affect platelet function

A 
ASA
NSAIDs
Dipyradimole
Clopidogrel
Ticlopidine
Ticagrelor
Abciximab
Eptifibitide
Nitrates
Ca channel blockers
Heparin
22
Q

List inherited d/o of platelet function

A 
Bernard Soulier
Gray platelet syndrome
VW disease
Wiskott aldrich
Chediak hegashi
Hermansky pudlak
Glanzmann thrombasthenia
23
Q

Defect in gray platelet syndrome

A

Defect is in platelet alpha granules

24
Q

Defect in glanzmann thrombasthenia

A

Defect is in GPIIB/IIIA

25
Q

List d/o and clinical situations that influence platelet function

A 
Liver dz
Cardiopulmonary bypass
Uremia
Dysproteinemia
Myeloproliferative d/o
DM
Trauma
Acquired glanzmann thrombasthenia
26
Q

The diagnosis of essential thrombocythemia is based on persistent platelet count >600,000 in the absence of a secondary cause. Occasionally the count is sufficiently high (>1,000,000) that a secondary cause may be excluded. Approximately 1/2 of ET pts have ___ mutation

A

JAK2

[make sure Philadelphia chr is negative and pt does not have concomitant erythrocytosis to r/o CML and PRV]

27
Q

Tx plan for essential thrombocythemia

A

In pts <60 with no prior thromboembolic event and a platelet count <1000000, just observe

Higher risk pts are treated with myelosuppressive hydroxyurea + low dose ASA (can add IFN-a or anagrelide if needed)

28
Q

17 y/o male with easy bruisability and petechial rash on his legs; he reports a cold 1 month ago. He most likely has

A. Drug-related rash
B. ITP
C. DIC
D. TTP
E. IDK
A

B. ITP

29
Q

17 y/o male with easy bruisability and petechial rash on his legs; he reports a cold 1 month ago. He most likely has ITP. Platelet count is probably close to

A. 140,000
B. 357,000
C. 75,000
D. 30,000
E. 600,000
A

D. 30,000

30
Q

17 y/o male with easy bruisability and petechial rash on his legs; he reports a cold 1 month ago. He most likely has ITP. Platelet count is 41,000. He should be tx with

A. IVIG
B. Prednisone
C. Rituximab
D. Observation
E. Romiplostim
A

D. Observation

Usually don’t treat unless count is <30,000. Follow 1-2x/week to repeat platelet counts and make sure it is improving

31
Q

65 y/o man with DVT is put on enoxaparin and warfarin in the hospital. He has no other medical problems and is not taking any other medications. The platelet count on first hospital day is 175,000, but drops to 80,000 on hospital day 5, at which time physical exam is normal. Other than thrombocytopenia his CBC and CMP are normal. INR is 1.5 and aPTT is in therapeutic range. With the exception of decreased platelet numbers, the PB smear is normal.

The pt most likely has

A. ITP
B. DIC
C. TTP
D. HIT
E. Pseudothrombocytopenia
A

E. HIT

[enoxaparin is LMWH]

32
Q

65 y/o man with DVT is put on enoxaparin and warfarin in the hospital. He has no other medical problems and is not taking any other medications. The platelet count on first hospital day is 175,000, but drops to 80,000 on hospital day 5, at which time physical exam is normal. Other than thrombocytopenia his CBC and CMP are normal. INR is 1.5 and aPTT is in therapeutic range. With the exception of decreased platelet numbers, the PB smear is normal. He is dx with HIT. He should be managed with

A. Plasmapheresis
B. Discontinuing current meds and initiate argatroban
C. Repeat labs in heparin or citrate tubes
D. Discontinue enoxaparin only
E. IVIG

A

D. Discontinue enoxaparin only

Want to keep him on warfarin, bc he is in therapeutic range with his INR

33
Q

19 y/o F with 1 wk hx of 103 fever, arthralgias, myalgias; no clear febrile focus. Her spleen tip is palpable on deep inspiration. Labs demonstrate WBC 1.9 with 37% segs, 8% bands, 40% lymphs, 12% monos, 2% eos, 1% basos; Hb/Hct 11.2/35; plts 865K. Her findings most likely suggest

A. Acute bacterial illness
B. Acute viral illness
C. Acute leukemia
D. An indolent NHL
E. Parasitic infection
A

B. Acute viral illness

34
Q

19 y/o F with 1 wk hx of 103 fever, arthralgias, myalgias; no clear febrile focus. Her spleen tip is palpable on deep inspiration. Labs demonstrate WBC 1.9 with 37% segs, 8% bands, 40% lymphs, 12% monos, 2% eos, 1% basos; Hb/Hct 11.2/35; plts 865K. Her findings most likely suggest a viral illness (reactive process). Her thrombocytosis is best managed by

A. Splenectomy
B. Anagrelide
C. Oral ferrous sulfate
D. Observation
E. Hydroxyurea
A

D. Observation

Probably will improve in 7-10 days

35
Q

55 y/o man with diplopia, HA, sore fingers and hand that appears red which you diagnose as erythromelalgia. CBC shows WBC 9.9 with 75% segs, 23% lymphs, 2% monos; Hb 15.1/Hct47; plts 1.2 M. The pt most likely has

A. Cellulitis
B. Angiosarcoma
C. RA
D. Essential thrombocythemia
E. Toxic epidermal necrolysis
A

D. Essential thrombocythemia

36
Q

55 y/o man with diplopia, HA, sore fingers and hand that appears red which you diagnose as erythromelalgia. CBC shows WBC 9.9 with 75% segs, 23% lymphs, 2% monos; Hb 15.1/Hct47; plts 1.2 M. The pt most likely has ET. How would this be treated?

A. Cephalexin
B. Baby aspirin daily
C. Cytotoxic chemo
D. Debridement and skin graft
E. MTX
A

B. Baby aspirin daily

37
Q

66 y/o woman evaluated in hospital for abnormal bleeding. She was admitted yesterday for UTI and bacteremia. She has no other medical problems and is not on any additional medications. On PE, temp is 102.6, BP 85/60, pulse is 115/min and RR is 18/min. Bleeding is noted on mucous membranes around IV access sites. Multiple ecchymoses are present on arms and legs. Labs show Hb 8.5, plts 35,000; PT 15 sec, aPTT 30 sec, D-dimer elevated, fibrinogen decreased. Peripheral smear shows schistocytes.

This pt most likely has:

A. ITP
B. DIC
C. TTP
D. HIT
E. Pseudothrombocytopenia
A

C. TTP

Heme Lymph Exam II (13 decks)

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