Thrombocytopenia Flashcards
Etiology overview
- Reduced production
- Decreased survival
- Sequestration
- Dilutional
Causes of reduced production
- Selective impairment->durgs, infectin
- Nutritional deficiencies
- Bone marrow failure->aplastic anemia
- Bone marrow replacement
- Ineffective hematopoiesis
Causes of decreased survival
1. Immunological SLE, B cell lymphoid, RA, Antiphospholipid Infection, HIV, CMV ITP Drugs Post transfusion 2. Non-immunological DIC Microangiopathies \++hemangiomas HELLP
History if normal medical history and first time presenting with extremely low PLT count
New medication Quinine Infection, HIV? Pregnancy FHx Rheumatological Malignancy Surgery/transfusion Travel, malaria
If patient only has bleeding
Immune destruction
Drug/toxin
Clouded sensorium, renal anomalies
TTP
DIC
Further history
- Easy bruising, petechiae, epistaxis, gum bleeding, GI/GU
- Bone pain, night sweats, weight loss, nausea, anorexia, fatigue, weak, LLQ discomfort (splenomegaly)
- fever, hemoptysis, chills, rigors, rash, laryngitis, DNV
- Joint, arthraligia, morning stiff, malar, weight loss, cough, dyspnea, hx miscarriage, diarrheal illness (HUS), confusion and neurology (TTP)
- Surgery, confusion/dys/cough (DIC)
- Excess alcohol
- Atopy, hearing loss
- Symptoms of hypothyroid
- Fatigue, breathless, chest pain
- Old PLT counts
- FHx, diet, travel, illness, vaccinations, ICU, alcohol/drugs
- Medication history
Physical examination
General: petechiae, retinal hemorrhage, bleeding
- Hepatosplenomegaly/LN+, adenopathy, bone pain/ fracture/weakness (MM), pallor
- White spots on tongue, jaundice/+liver, retinal changes (CMV)
- Joint deformity, LN, rash
- Hypotension/tachy/bleed (DIC), HTN in pregnancy (HELLP), seizures/arrythmia/jaundice (TTP)
- Bleeding at IV/catheter sites etc
- Peripheral edema/hair loss/bradyC/hypothyroid
- Evidence of cirrhosis/portalhypertension
Investigations
- Peripheral smear
- FBC w/ differential
- CT head if IC bleed suspected
Results of smear determine further testing
1. Plasma electrophoresis, serum calcium, beta2mucroglobulin, BM aspirate, XR
2. Serum LDH, reticulocyte, indirect bilirubin, PT, PTT, fibrinogen, d dimer, creatinine->TTP
3. If cirrhosis suspected: LFTs, albumin, coags, ANA, ferritin, anti-SM, ceruloplasmin, USS, ammonia etc
4. CT abdomen->cirrhosis, splenomegaly, mets, lymphoma
5. If AI->ANA, RF, anti cardiolipin, lupus anticoagulant, CXR
6. BM if suspect aplastic anemia
7/ B12 and folate
8. Renal function
9. Infection: CMV, EBV, HIV, ,malaria