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Haematology > Thrombocytopenia > Flashcards

Thrombocytopenia Flashcards

1
Q

What is thrombocytopenia?

A

A low platelet count.

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2
Q

What is a normal platelet count?

A

Between 150 to 450 x 109/L.

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3
Q

What can the causes of thrombocytopenia be split into?

A

Problems with production

Problems with destruction

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4
Q

What conditions can cause problems with platelet production?

A
  • Sepsis
  • B12 or folic acid deficiency
  • Liver failure causing reduced thrombopoietin production in the liver
  • Leukaemia
  • Myelodysplastic syndrome
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5
Q

What conditions can cause platelet destruction?

A
  • Medications
  • Alcohol
  • Immune thrombocytopenic purpura
  • Thrombotic thrombocytopenic purpura
  • Heparin-induced thrombocytopenia
  • Haemolytic-uraemic syndrome
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6
Q

What medications can result in platelet destruction?

A 
Sodium valproate
Methotrexate
Isotretinoin
Antihistamines
Proton pump inhibitors
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7
Q

How might mild thrombocytopenia present?

A

Asymptomatic and found incidentally on a full blood count.

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8
Q

What platelet count indicates thrombocytopenia?

A

Platelet counts below 50 x 109/L

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9
Q

What will a platelet count below 50 x 109/L cause?

A
  • Easy or spontaneous bruising
  • Prolonged bleeding times.
  • Nosebleeds, bleeding gums, heavy periods or blood in the urine or stools.
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10
Q

What are people with a platelet count of below 10 x 109/L at high risk of?

A

They are high risk for spontaneous bleeding.

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11
Q

What is of particular concern in someone with a platelet count of below 10 x 109/L?

A

Spontaneous intracranial haemorrhage or GI bleeds

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12
Q

What are differential diagnosis of abnormal or prolonged bleeding?

A

Blood clotting system breaks down

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13
Q

What are some conditions that are due to the blood clotting system breaking down?

A
  • Thrombocytopenia (low platelets)
  • Haemophilia A and haemophilia B
  • Von Willebrand Disease
  • Disseminated intravascular coagulation (usually secondary to sepsis)
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14
Q

What are other names for Immune Thrombocytopenic purpura (ITP)?

A
  • Autoimmune thrombocytopenic purpura
  • Idiopathic thrombocytopenic purpura
  • Primary thrombocytopenic purpura.
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15
Q

What is ITP?

A

A condition where antibodies are created against platelets

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16
Q

What does ITP cause?

A

An immune response against platelets, resulting in the destruction of platelets and a low platelet count.

17
Q

What is the first line management of ITP?

A

Prednisolone (steroids)

18
Q

What would you add for medical management of ITP if prednisolone didn’t work?

A

IV immunoglobulins

19
Q

What additional management can you do for ITP?

A

Monitor platelet count
Educate patient about concerning signs of bleeding: persistent headaches and melaena
Careful controlling of blood pressure
Suppressing menstrual periods

20
Q

What might you suppress in a girl with ITP?

A

Menstrual periods

21
Q

What is thrombotic thrombocytopenic purpura?

A

A condition where tiny blood clots develop throughout the small vessels of the body

22
Q

What does thrombotic thrombocytopenic purpura use up?

A

It uses up the platelets

23
Q

Why is thrombotic thrombocytopenic purpura described as microangiopathy?

A

Affects the small vessels

24
Q

What does thrombotic thrombocytopenic purpura cause?

A 
fever
fluctuating neuro signs (microemboli)
microangiopathic haemolytic anaemia
thrombocytopenia
renal failure
25
Q

Why do the blood clots develop in thrombotic thrombocytopenic purpura?

A

They develop due to a problem with a specific protein called ADAMTS13.

26
Q

What is the normal function of ADAMTS13?

A

ADAMTS13 (a metalloprotease enzyme) which breakdowns (‘cleaves’) large multimers of von Willebrand’s factor

27
Q

What might be used in the management of thrombotic thrombocytopenic purpura?

A

Plasma exchange
Steroids
Rituximab

28
Q

What is Heparin Induced Thrombocytopenia?

A

Development of antibodies against platelets in response to exposure to heparin.

29
Q

What do the heparin induced antibodies target?

A

These heparin induced antibodies target a protein on the platelets called platelet factor 4 (PF4).

30
Q

What do the PF4/anti-heparin antibodies bind to?

A

Platelets and activate clotting mechanisms.

31
Q

What do the PF4/anti-heparin antibodies create?

A

A hypercoagulable state and leads to thrombosis.

32
Q

What can happen to a patient on heparin?

A

They form unexpected blood clots

33
Q

How is heparin induced thrombocytopenia diagnosed?

A

Test for the HIT antibodies in the patients blood.

34
Q

What is the management for heparin induced thrombocytopenia?

A
  • Stop heparin

* Use alternative anticoagulant

Haematology (36 decks)

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