Platelets: Qualitative & Quantitative Part 2

Question 1

Discuss Thrombocytopenic purpura (TTP): Predisposing factors

Answer 1

Infectious diseases, autoimmune diseases, drugs, pregnancy, hereditary

Question 2

Discuss Thrombocytopenic purpura (TTP): clinical presentation

Answer 2

• Characterized by: MAHA, Thrombocytopenia, Neurologic dysfunction
• Mostly in adults

Question 3

Discuss Thrombocytopenic purpura (TTP): platelet count

Answer 3

Decrease

Question 4

Discuss Thrombocytopenic purpura (TTP): RBC morphology

Answer 4

• Decrease RBC, Hemoglobin, hematocrit
• increase reticulocytes
• poik-SCHISTOS!!!
• coag tests usually normal but it helps to distinguish from DIC

Question 5

Discuss Thrombocytopenic purpura (TTP): Type of anemia/mechanism

Answer 5

Underlying disorder that damages vascular endothelium caused by ultra high molecular weight vWF multimers present when endothelial cell secreted vWF is not properly proteolysed by its cleaving protease. promotes deposition of platelet thrombi.

Question 6

Discuss Hemolytic uremic syndrome (HUS): predisposing factors

Answer 6

-Acquired disorder that resembles TTP characterized by MAHA and Thrombocytopenia

Question 7

Discuss Hemolytic uremic syndrome (HUS): clinical presentation in contrast to TTP

Answer 7

• usually no neurological manifestations
• intravascular clotting confined to kidney leading to acute renal failure
• associated with bacterial toxins

Question 8

Discuss Hemolytic uremic syndrome (HUS): platelet count

Answer 8

decreased

Question 9

Discuss Hemolytic uremic syndrome (HUS): RBC morphology

Answer 9

• similiar to TTP

- Additionally, abnormal urinalysis results: proteinuria, hematuria, RBC casts often

Question 10

Discuss Hemolytic uremic syndrome (HUS): Clinical findings in children

Answer 10

• Classic HUS occurs in infants <2 yrs age

- children present after a febriile illness with: vomiting, bloody diarrhea, MAHA leads to renal failure, Hypertension

Question 11

Discuss thrombocytopenic purpura (TTP): clinical findings.

Answer 11

• Neurological manifestations: headache, seizures, vertigo, delirium
• Hemorrhagic symptoms (MAHA): jaundice, pallor, Acute renal failure

Question 12

Discuss Hemolytic uremic syndrome (HUS): clinical findings in adults

Answer 12

Link with malignancy and/or chemotherapy (and HUS) in adults

Question 13

Discuss acute Idiopathic (immune) thrombocytopenic purpura (ITP): age of oneset

Answer 13

Childhood

Question 14

Discuss acute Idiopathic (immune) thrombocytopenic purpura (ITP): Previous infections?

Answer 14

Common

Question 15

Discuss acute Idiopathic (immune) thrombocytopenic purpura (ITP): Platelet count

Answer 15

Decreased (<20,000/uL), so BM exam requested

Question 16

Discuss acute Idiopathic (immune) thrombocytopenic purpura (ITP): bleeding characteristics

Answer 16

Abrupt onset of bruising, petechiae, and sometimes mucosal bleeding in a previously healthy patient

Question 17

Discuss acute Idiopathic (immune) thrombocytopenic purpura (ITP): occurrence of spontaneous remission?

Answer 17

occurs in majority of patients

Question 18

Discuss acute Idiopathic (immune) thrombocytopenic purpura (ITP): treatment

Answer 18

• Some patients do not require treatment due to spontaneous remissions
• Severe causes require platelet transfusions and/or splenectomy (as spleen is primary site of platelet destruction

Question 19

Discuss chronic Idiopathic (immune) thrombocytopenic purpura (ITP): age of oneset

Answer 19

20-50 years: females over males

Question 20

Discuss chronic Idiopathic (immune) thrombocytopenic purpura (ITP): Previous infections?

Answer 20

usually not associated

Question 21

Discuss chronic Idiopathic (immune) thrombocytopenic purpura (ITP): Platelet count

Answer 21

variable, 30,000 to 80,000/uL

Question 22

Discuss chronic Idiopathic (immune) thrombocytopenic purpura (ITP): bleeding characteristics

Answer 22

Insidious

Question 23

Discuss chronic Idiopathic (immune) thrombocytopenic purpura (ITP): occurrence of spontaneous remission?

Answer 23

Relatively rare

Question 24

Discuss chronic Idiopathic (immune) thrombocytopenic purpura (ITP): treatment

Answer 24

• Treat with steroids

- refractory cases may require splenectomy and/or chemotherapeutic agents

Question 25

Describe heparin-induced thrombocytopenia (HIT), type II, according to the basis for the possible thrombotic and hemorrhagic presentation.

Answer 25

-In HIT, PF4 & heparin combine to form a surface complex against which the IgG antibody is directed: platelets become activated, in vivo platelet aggregation with thrombosis is possible. So, thrombotic and hemorrhagic problems

Question 26

An adverse effect of heparin therapy is called_____

Answer 26

Heparin-induced Thrombocytopenia (HIT)

Question 27

Develops when the mother lacks a specific platelet-specific Antigen that the fetus has inherited from the father.

Answer 27

Neonatal alloimmune thrombocytopenia

Question 28

How do we get thrombocytopenia in neonatal?

Answer 28

Mother produces antibodies to the fetal antigen which cross the placenta, and attach to the Ag-bearing fetal platelets, resulting in thrombocytopenia

Question 29

This is autosomal dominant inheritance and giant dohle-like bodies in neutrophils, eos, basos, and monos are seen.

Answer 29

May-Hegglin Anomaly

Question 30

Name four clinical states in which thrombocytosis can be seen.

Answer 30

Hemorrhage or surgery
inflammation
exercise-induced
FDA

Question 31

Describe thrombocytosis according to the etiology and the platelet count values

Answer 31

• Etiology: reactive phenomena–secondary to hemorrhage or surgery, inflammation, exercise-induced, FDA???
• Platelet count is increased but usually <1,000,000/cumm

Question 32

Describe thrombocythemia according to the etiology and the platelet count values.

Answer 32

• MP disorder cause is unknown

- Platelet count usually exceeds 1,000,000/cumm