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Hematology/Oncology > Thrombocytopenia > Flashcards

Thrombocytopenia Flashcards

1
Q

what are thrombocytes

A

small disked shaped cell fragments without a nucleus. They are produced in the marrow and derived from megakaryocytes.
-they are involved in clotting

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2
Q

what is the average life span of thrombocytes in peripheral blood under normal circumstances?

A

7days

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3
Q

where are reserved platelets stored?

A

in the spleen and it is released when it is needed

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4
Q

where are platelets destroyed?

A

in the spleen

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5
Q

what is the normal range for platelets?

A

150,000-300,000

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6
Q

what is the causes of thrombocytopenia if its not associated with anemia or leukopenia

A

accelerated platelet destruction

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7
Q

What does MINI stand for?

A 
things that can cause thrombocytopenia
M-metabolic
I-Infectious
N-Neoplastic
I-Inflammatory/Immune
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8
Q

what things that are metabolic that will causes thrombocytopenia

A

drugs:heparin, penicillins, sulfas, anticonvulsants, Quinine
-Thrombotic Throbocytopenic Purpura
Hemolytic Uremic Syndrome
Severe bleeding or Hypersplenism

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9
Q

what are the infectious things that will cause thrombocytopenia?

A

particularly HIV and other Viral infections
Sepsis
DIC

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10
Q

what are the Neoplastic things that will cause thrombocytopenia?

A

DIC

Myelophthisis

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11
Q

what are the inflammatory/Immune things that will causes Thrombocytopenia

A

ITP

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12
Q

What is heparin induced thrombocytopenia?

A

HIT
immune mediated by anti-heparin antibodies
Associated with diffuse inta-vascular thrombosis and end organ ischemia
This is urgent the heparin needs to be stopped as one considers this Dx

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13
Q

When does HIT occur and What classifies a platelet count as HIT?

A

occur after D#5 of treatment or at re-expososure
Platelets are usually 25,000-75,000
bleeding is rare

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14
Q

how is hit diagnosed

A

by ordering test for a heparin induced anti-platelet antibodie

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15
Q

What are the other drugs know for causing thrombocytopenia

A

Penicillins and Ceephalosporins
Sulfa drugs
Anticonvulsants
Quinine containing drugs or beverages

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16
Q

what is the only definitive Dx and Rx for thrombocytopenia?

A

withdrawal of the suspected medication

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17
Q

What creates thrombocytopenia

A

microthrombi forming in the small vessels consuming platelets and incuding a microangiopathic hemolytic anemia which cause RBC’s to be broken down as they pass through strands of fibrin

18
Q

what are signs of thrombocytopenia

A 
flucutuating neurological Sx
Abnormal speech
confusion
jaundice
purpura/petechiae
19
Q

what is the pentad of Thrombotic thrombocytopenic purpura & hemolytic Uremic syndrome

A

Microangiopathic hemolytic anemia, Thrombocytopenia, renal failure, fluctuating neurologic signs and symptoms & fever

20
Q

what is it called when renal failure dominates

A

Hemolytic Uremic syndrome

21
Q

What are associated conditions

A

Viral infx, hemorrhagic diarrhea w.ecoli, pregnancy, clopidogrel, cyclosporin

22
Q

what is the lab test for diagnosis of TTP

A

microangiopathic hemolytic anemia with thrombocytopenia
normal clotting studies
increase LDH (lactate dehydrogenae) indirect bilirubin, retic with a negative direct coombs test
decrease hatpoglobin

23
Q

what is the Tx for TTP or HUS

A

Urgent plasmapharesis
If offending agent can be identified it should be withdrawn
Steriods may help

24
Q

what needs to be done if renal failure is predominant

A

dialysis

25
Q

What infectious etiologies cause thrombocytopenia

A

mononucleosis EBV

26
Q

what is the treatment for infectious etiologies

A

supportive or steroids

27
Q

how do you treat patient with HIV associated thrombocytopenia

A

should be treated with HAART (highly active anti retroviral therapy)

28
Q

what is DIC

A

diffuse intravascular activation of the clotting system with associated mircoangiopathic hemolytic anemia and multi organ failure

29
Q

what causes DIC

A

infections or cancers can activate the clotting system
Platelets are decreasing, soluble clotting factors are decreasing, but PT and PTT and fibrin split products are increasing

30
Q

what is the Tx for DIC

A

Fresh frozen plasma

Heparin is rarely helpful

31
Q

what are the two mechanism that cancer can cause thrombocytopenia

A

DIC, myelophthisis

32
Q

what is myelophthisis

A

diffuse bone marrow infiltration crowds out the normal marrow

33
Q

what is ITP

A

it is an auto immune condition with antibodies directed against several platelet associated surface antigens
The anti-bodies bind to platelets that leads to platelet destruction in the spleen

34
Q

what is the epidemiology

A

children account for half of the new cases each year
childhood cases are usually self limiting
Adult cases are chronic

35
Q

what is the presentation like with a patient who has a platelet count 20,000-100,000

A

may be asymptomatic and discovered fortuitously

may be associated with easy bruising or heavy menses

36
Q

what is the presentation like with a patient who has a platelet count 5,000-20,000

A

spontaneous bruises and hematoma formation

mucoucutaneous bleeding

37
Q

what is the presentation like with a patient who has a platelet count < 5,000

A

intracranial hemorrhages
GI bleeding
Spontaneous Organ bleeding

38
Q

what is more important that absolute platelet count

A

patients clinical presentation
-does pt have wet purpura “blood blisters in the mouth or nose, nose bleeds, or GI bleeding or retinal hemorrhages
Wet purpura are a grave sign that requires urgent intervention
High dose steroids
IVIG

39
Q

what are urgent clinical features that may prompt more urgent aggressive treatment

A 
fever
malnutrition
advanced age
extensive comorbidities
inability to cooperate with outpatient therapy
40
Q

what do lab results look like for ITP

A

other blood counts and hematopoietic cell lines are normal
Peripheral smear normal except sometimes with giant platelets and associate low platelet counts
normal bone marrow, though bone marrow evaluation rarely neede

41
Q

how is ITP treated

A

guidelines recommend on treating in cases with platelets <30,000 or significant bleeding
main stay steroids
second line if refractory to steroids is IVIG, rituxumab, Anti-Rh-D
thrombopoietin receptor agnoists
last resort slpenectomy

42
Q

when should platelet transfusion be used

A

should be reserved for cases with significant or life threatening bleeding
Allo-antibodies to transfused platelets invariably develop in patient who had multiple platelet transfusions

Hematology/Oncology (7 decks)

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