Thrombocytopenia

Question 1

What is thrombocytopenia?

Answer 1

• Described as a low platelet count

Question 2

What is the normal range for platelets?

Answer 2

• 150-450

Question 3

What are the problems with production for Thrombocytopenia?

Answer 3

• Sepsis
• B12 or Folic Acid Deficiency
• Liver Failure (reduced thrombopoietin)
• Leukaemia
• Myelodysplastic Syndrome

Question 4

What are the problems with destruction?

Answer 4

• Medications (sodium valproate, methotrexate, antihistamines)
• Alcohol
• Immune Thrombocytopenic Purpura
• Thrombotic Thrombocytopenic Purpura
• Heparin- Induced Thrombocytopenia
• Haemolytic- Uraemic Syndrome

Question 5

How do platelet counts less than 50 present?

Answer 5

• Spontaneous bruising and prolonged bleeding times
• Nosebleeds, Bleeding gums, heavy periods, bleeding in the urine/stools

Question 6

How do platelets counts below 10 present?

Answer 6

• High risk for spontaneous bleeding
• Spontaneous Intracranial haemorrhage
• GI bleeds

Question 7

What are the differential diagnosis for abnormal/ prolonged bleeding?

Answer 7

• Thrombocytopenia
• Haemophilia A and B
• Von Willebrand Disease
• DIC ( secondary to sepsis)

Question 8

What is Immune Thrombocytopenic Purpura (ITP)

Answer 8

• Antibodies are created against platelets
• Immune response resulting in the destruction of platelets and therefore a low platelet count

Question 9

What is the management of ITP?

Answer 9

• Prednisolone (steroids)
• IV immunoglobulins
• Rituximab
• Splenectomy

Question 10

What information should you tell patients with ITP?

Answer 10

Be aware for signs of bleeding such as:
- Persistent headaches and melaena
- Measure Blood Pressure and suppress menstrual periods

Question 11

What is Thrombotic Thrombocytopenic Purpura?

Answer 11

• This is a condition where tiny blood clots develop throughout the small vessels using up platelets
• it affects the small vessels = microangiopathy
• Blood clots develop due to a problem with the ADAMTS13 protein
• This protein normally inactivates von Willebrand factor, which reduces platelet adhesion and clot formation
• However, a lack of the ADAMTS13 protein leads to excess von Willebrand factor, so platelets are used up leading to thrombocytopenia
• The blood clots break up RBC leading to Haemolytic Anaemia
• ## Deficiency in ADAMTS13 can an inherited genetic mutation or due to autoimmune disease

Question 12

What is the treatment for Thrombotic Thrombocytopenic Purpura?

Answer 12

• Plasma Exchange
• Steroids
• Rituximab

Question 13

What is Heparin Induced Thrombocytopenia?

Answer 13

• HIT involves the development of antibodies against platelets in response to Heparin
• Heparin Induced Antibodies specifically target a protein on platelets known as Platelet factor 4
• HIT antibodies bind to platelets and activate clotting
• Leading to a hypercoagulable state and thrombosis
• But they also bind and break down platelets = thrombocytopenia
• Leading to low platelets with unexpected blood clots

Question 14

How do you manage HIT?

Answer 14

• Test for HIT antibodies
• Managment = stopping heparin and alternative anticoagulant