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Hematology > Thrombocytopenia > Flashcards

Thrombocytopenia Flashcards

1
Q

What is thrombocytopenia?

A

Low platelets

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2
Q

What are the three underlying causes of thrombocytopenia?

A

Underproduction
Destruction
Sequestration

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3
Q

What is the normal ranges of platelets?

A

150-450k

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4
Q

How big are platelets relative to RBCs?

A

1/3 size

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5
Q

What is the cell that produces platelets?

A

Megakaryocytes

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6
Q

What is the chemical that determines the rate and amount of platelet production?

A

Thrombopoietin

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7
Q

What are the receptors on platelets that binds to vWF, and serves as an intracellular signal?

A

Gp IIb/IIIa

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8
Q

Stocking distribution of paresthesias with low pancytopenia =?

A

Pernicious anemia

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9
Q

Where are platelets sequestered, generally?

A

Spleen

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10
Q

What are the viral causes of thrombocytopenia? (2)

A

HIV

Parvo B19

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11
Q

Pts with sickle cell disease are susceptible to what viral infections?

A

Parvovirus B19

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12
Q

What are the two common causes of thrombocytopenia that fall under the medication/drug category?

A

EtOH

Chemotherapeutic agents

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13
Q

What are the three causes of marrow replacement that causes thrombocytopenia?

A

Granulomatous disease
Myelofibrosis
Malignancies

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14
Q

If the MCV is greater than 115, what is the disease?

A

megaloblastic anemia

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15
Q

What are the two platelet dysfunctions with pernicious anemia?

A

Diminished platelet aggregation

Decreased release of ATP, ADP

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16
Q

Elevated methylmalonic acid levels = ?

A

Pernicious anemia

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17
Q

What are the tests to diagnose pernicious anemia? (3)

A

Anti-parietal cell
Anti IF
EGD

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18
Q

What is the treatment for pernicious anemia?

A

SQ B12 replacement (can’t give PO d/t lack of IF)

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19
Q

Why is an EGD indicated for pernicious anemia?

A

Gastric adenocarcinoma

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20
Q

What is pseudothrombocytopenia?

A

Platelet aggregation or clumping in the test tube (in vitro)

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21
Q

What is the solution to pseudothrombocytopenia?

A

Use a blue top tube with heparinized blood

22
Q

thrombocytopenia with o/w normal CBC + bleeding from gums + mucocutaneous petechial rash = ?

A

ITP (immune thrombocytopenia purpura)

23
Q

What is ITP?

A

Accelerated destruction of platelets by immune destruction

24
Q

How do you diagnose ITP?

A

Diagnosis of exclusion

25
Q

What are the results of a bone marrow biopsy with ITP?

A

Normal to increased number of megakaryocytes

26
Q

The incidence of ITP increases or decreases with age

A

Increases

27
Q

What are the antiplatelet abs that are involved in ITP targeted against?

A

IgG to GPII/IIIa receptor

28
Q

True or false: transfusions to pts with ITP still result in destruction of platelets

A

True

29
Q

What are the usual symptoms of ITP?

A

Purpura/petechiae
Epistaxis/bleeding gums
Menorrhagia

30
Q

What is the first line of drug treatment for ITP? Second? Third?

A

IV corticosteroids

IVIG

Rituximab

31
Q

What is the last resort for ITP treatment?

A

Splenectomy

32
Q

What is antiphospholipid antibody syndrome?

A

Abs to GPIIa/IIIb

33
Q

Is HUS/TTP immune mediated?

A

no

34
Q

HELLP syndrome is indicated by what? (3)

A

Low platelet
HTN
elevated LFTs

35
Q

HIT is caused by what?

A

Immune mediated destruction of platelets after exposure to heparin

36
Q

What do abs in HIT attach to?

A

heparin and PF4 complex

37
Q

What type of heparin has a lower risk of HIT?

A

Low molecular weight heparin

38
Q

What happens to HIT pts when they are left untreated?

A

Thromboses form

39
Q

How do you manage HIT?

A

Stop heparin

Change anticoag

40
Q

True or false: you can administer heparin in pts who have had HIT before?

A

True, but needs to be more than 6 months

41
Q

Jaundice everywhere but the sclera is what?

A

NOT hyperbilirubinemia–Hyperbetacarontenamia

42
Q

Thrombocytopenia d/t to sequestration generally results in what PE findings?

A

Splenomegaly

43
Q

What are the four causes of splenic sequestration?

A

1/ Hereditary spherocytosis

  1. CML
  2. Hairy cell leukemia
  3. MALT lymphoma
44
Q

True or false: DM is a common cause of liver cirrhosis

A

True

45
Q

What are the three components of thrombocytopenia?

A
  1. Careful H&P
  2. Lab eval
  3. Bone marrow biopsy
46
Q

What are the three things to look for in a PE of thrombocytopenia?

A

Mucocutaneous exam
Lymphadenopathy
Splenomegaly

47
Q

What are the two diseases that contraindicate platelet transfusion? Why?

A

ITP
HIT

May accelerate platelet destruction

48
Q

For every unit of blood, how much increase in platelets should you expect?

A

5k

49
Q

What are the three things that should be a part of a PE for pts with thromboytopenia?

A

Mucocutaneous
Lymph
Spleen

50
Q

When is a bone marrow biopsy indicated?

A

2 or more cell lines affected

51
Q

What is the more common cause of underproduction thrombocytopenia?

A

Drugs

52
Q

What is the tube that should be used to r/o pseudothrombocytopenia?

A

Blue top

Hematology (32 decks)

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