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HEM Exam 1 > Platelets Too Few and Too Many > Flashcards

Platelets Too Few and Too Many Flashcards

1
Q

thrombocytopenia

A
  • too few platelets
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2
Q

thrombocytosis other name

A
  • thrombocythemia
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3
Q

thrombocytosis

A
  • too many platelets
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4
Q

when evaluating a patient with thrombocytopenia, first make sure the patient doesn’t have

A
  • pseudothrombocytopenia
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5
Q

another name for pseudothrombocytopenia

A
  • platelet clumping
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6
Q

platelet count in tubes in pseudothrombocytopenia

A
  • falsely low

- make a substance that causes platelets to clump when blood added to EDTA tubes

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7
Q

platelet count in vivo in pseudothrombocytopenia

A
  • higher
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8
Q

bleeding consequences in pseudothrombocytopenia

A
  • no bleeding consequences
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9
Q

treatment in pseudothrombocytopenia

A
  • no treatment needed
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10
Q

first symptoms appear at a platelet count of

A

50-20

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11
Q

usually need to treat at a platelet count of

A

20-10

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12
Q

risk of spontaneous intracranial hemorrhage at a platelet count of

A

< 10

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13
Q

three categories of thrombocytopenia

A
  • underproduction
  • peripheral destruction
  • splenic sequestration
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14
Q

underproduction due to

A
  • marrow failure
  • marrow infiltration
  • marrow toxins
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15
Q

marrow failure conditions

A
  • myelodysplasia
  • asplastic anemia
  • vitamin deficiencies
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16
Q

marrow infiltration conditions

A
  • tumor
  • granulomatous diseases
  • fibrosis
  • leukemias
  • lymphomas
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17
Q

marrow toxins

A
  • drugs (chemo)
  • radiation
  • infections
  • alcohol
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18
Q

non-immune mechanisms of peripheral destruction

A
  • DIC

- TTP

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19
Q

immune mechanism of peripheral destruction

A
  • antibody mediated platelet destruction
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20
Q

antibody mediated platelet destruction

A
  • provoked by drugs
  • associated with HIV
  • associated with other autoimmune disease
  • can be idiopathic
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21
Q

DIC characterized by

A
  • abnormal activation of coagulation
  • generation of thrombin
  • consumption of clotting factors
  • destruction of platelets
  • activation of fibrinolysis
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22
Q

DIC diagnosis

  • PT
  • platelets
  • fibrinogen
  • D dimers
  • peripheral smear
A
  • elevated PT
  • low platelets
  • low fibrinogen
  • elevated D dimers
  • schistocytes on peripheral smear
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23
Q

elevated PT in DIC due to

A
  • consumption of factor VII
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24
Q

treatment of DIC

A
  • treat underlying cause
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25
Q

DIC etiologies

A
  • gram negative sepsis
  • severe burns
  • obstetrical disasters
  • leukemias
  • shock
  • insect or snake venoms
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26
Q

supportive measures of DIC

A
  • transfusion of platelets
  • clotting factors (FFP)
  • fibrinogen (cryoprecipitate)
27
Q

TTP characterized by

A
  • abnormal activation of platelets and endothelial cells with vWF and fibrin deposition in microvasculature
  • peripheral destruction of platelets and red cells
28
Q

TTP diagnostic features

A
  • MAHA
  • low platelets
  • fever
  • neurologic manifestations
  • renal manifestations
29
Q

MAHA features in TTP

A
  • elevated LDH
  • elevated bilirubin
  • schistocytes
30
Q

renal manifestations in TTP

A
  • hematuria
  • proteinuria
  • elevated BUN/creatinine
31
Q

TTP etiology

A
  • due to antibody against ADAMTS-13 protease
32
Q

role of ADAMTS-13 protease

A
  • cleaves large molecular weight vWF
33
Q

result of antibody blocking function of ADAMTS-13 protease

A
  • accumulation of large molecular weight vWF multimers
34
Q

result of large vWF multimers

A
  • abnormal platelet activation
35
Q

TTP can be induced by

A
  • drugs
  • pregnancy
  • HIV/AIDS
36
Q

drugs that can induce TTP

A
  • quinine
  • cyclosporine
  • tracrolimus
37
Q

% fatality of TTP without therapy

A

> 90%

38
Q

% who survive TTP with therapy

A

80-90%

39
Q

TTP treatment relies on

A
  • plasma exchange (PLEX)

- corticosteroids

40
Q

secondary measures of TTP treatment

A
  • spenectomy

- rituximab

41
Q

TTP and platelet transfusions

A
  • avoid platelet transfusions
42
Q

HUS preciptated by

A
  • diarrheal illness

- shiga toxin E. coli

43
Q

atypical HUS

A
  • HUS without diarrhea
44
Q

atypical HUS cause

A
  • inherited disorder of complement regulation
45
Q

trigger of atypical HUS

A
  • infection

- pregnancy

46
Q

clinical features of Atypical HUS

A
  • MAHA
  • thrombocytopenia
  • renal failure
  • evidence of complement activation
47
Q

treatment of atypical HUS

A
  • plasma exchange

- eculizumab

48
Q

drugs that can cause thrombocytopenia

A
  • beta lactams
  • trimoprim-sulfamethoxozole
  • sulfa drugs
  • quinine
  • heparin
49
Q

heparin induced cytopenia caused by

A
  • antibodies against heparin/PF4
50
Q

if platelets fall while patient is on heparin

A
  • stop heparin immediately
51
Q

heparin induced thrombocytopenia can also lead to

A
  • thrombosis
52
Q

diagnostic test for ITP-

A
  • no diagnostic test
53
Q

suspect ITP in patients with

A
  • isolated thrombocytopenia
54
Q

In adults specific therapy required for ITP if patient’s platelet count is

A
  • < 20-30
55
Q

initial therapy of ITP relies on

A
  • corticosteroids
56
Q

if platelet count is <10 or patient is bleeding In ITP, what do you use to treat

A
  • IVIg
57
Q

second line treatment of ITP

A
  • rituximab

- splenectomy

58
Q

blood bank platelet count

A
  • will have a platelet count above which they will not release platelets
  • not a magic number that should serve as a trigger to transfuse platelets
59
Q

platelet transfusions in ITP

A
  • only if severe bleeding
60
Q

platelet transfusion in TTP

A
  • contraindicated
61
Q

platelet transfusion in DIC

A
  • give to treat bleeding
62
Q

platelets transfusions for splenic sequestration

A
  • only for severe bleeding
63
Q

hypo production platelet number to transfuse

A
  • 10K

HEM Exam 1 (22 decks)

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