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Hematology > Thrombocytopenia > Flashcards

Thrombocytopenia Flashcards

1
Q

thrombocytopenia

A

platelet counts less than 150,000

  • common cause of abnormal bleeding
  • decreased production of platelets or increased destruction of platelets
  • sequestration
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2
Q

types of thrombocytopenia

A

ITP
NATP
TTP
TAR

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3
Q

ITP

A

immune thrombocytopenic purpura

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4
Q

PP of ITP

A

antibody that binds to plateltet membrane

-common in children after a viral infxn

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5
Q

CF of ITP

A

1-4 wks post viral illness
-abrupt onset of petechia, brusing, epistaxis

+/- hemorrhagic bullae on skin and mucus membrane

  • no splenomegaly
  • heparing is the drug tha tmost commonly cuases ITP like rx in hospitalized pts (HIT)

can be caused by SLE or CLl

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6
Q

drugs that may cause ITP

A

sulfonamides, quinine, thiazides, cimetidine, gold,

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7
Q

lab eval of ITP

A

severe thrombocytopenis, smear that shows megathrombocytes, coag studes are normal

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8
Q

dx of ITP

A

PE

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9
Q

tx of ITP

A
  • benign self-limiting

- if indicated: steroids, IVIG, anti-D immunoglobulin (chronic ITP)

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10
Q

what should you avoid in ITP

A

antiplatelet meds (nsaid)

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11
Q

NATP

A

neonatal alloimmune thrombocytopenic purpura

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12
Q

PP of NATP

A
  • Occurs as the result of sensitization of mother to antigens present on fetal platelets
    o Antibodies cross the placenta & attack fetal platelets
    o Infant at risk for intracranial hemorrhage in utero
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13
Q

lab dx of NATP

A

fetal scalp sampling or percutaneous umbilical blood smpaling to measure fetal platelet count

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14
Q

tx of NATP

A

c-section, infants may need steroids after birth

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15
Q

TTP

A
  • congenital or acquired def of enzyme needed to cleave von willebrand factor
  • congenital is RARE and often fatal
  • women, HIV +
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16
Q

what can preciptate TTP?

A

estrogen use, preg, drugs (quinidine and ticlopindine)

17
Q

CF of TTP

A
  • jaundiced or pale
  • purpura, petechiae, pallor, abdom pain, microangiopathic hemolytic anemia, fever
  • may have renal dz
  • +/- pancreatitis, recurrent episodes are common
18
Q

Lab evaluation of TT

A

o Severe thrombocytopenia
o Typically have schistocytes in circulation (red cell fragmentation)
o RBC destruction
o Negative Coombs’ test
o Markedly elevated LDH. Increased indirect bilirubin
o Coagulation tests are normal

19
Q

tx of TTP

A

plasma exchange, prednisone and antiplatelt

20
Q

HUS

A

hemolytic uremia syndrome

21
Q

HUS?

A

similar to TTP but found primarly in kids (younger than 10, particularly after infx w. e coli, shigella, or salmonella

22
Q

what can precipitate HUS in adluts?

A

preg and estrogen use

23
Q

lab values of HUS?

A

similar to TTP, but thrombocytopenia is less severe

24
Q

tx of HUS

A

kids- conservative, fluids/ electorlyte balance

adults -plasmapheresis

25
Q

TAR

A

Thrombocytopenia w. absent radii syndrome

26
Q

TAR?

A

congenital megakaryocytic hypoplasia, autosomal recessive

** associated w/ orthopedic abnormalities

27
Q

CF of TAR

A

**uppper extremities (thumbs are present)

  • no radii is pathognomonic
  • thrombocytopenia resolves over time (usually by 1 year)
28
Q

tx of TAR

A

freqent platelet transfusion up to age 1 yr

29
Q

DIC

A

disseminated intravasuclar coagulation

30
Q

DIC?

A

severe illness that laters the homeostasis btw hemorrhage and thrombosis, so there is activation of both coagulation and fibrinolysis

31
Q

what conditions are associated w/ DIC

A

spesis, burns , tissue injurt, obstetric complications, truama, ashyxia, malignancy, cirrhosis, sever transfusion rxn

32
Q

CF of DIC

A
  • Generalized hemorrhage in patients with severe underlying systemic illnesses
  • Diffuse bleeding diathesis, GI and pulmonary bleeding, hematuria
  • Thrombotic lesions affect the extremities, skin, kidneys, and brain
  • Ischemic and hemorrhage strokes can occur
33
Q

dx of DIC

A

 skin and mucous membrane bleeding (particularly at puncture/wound sites) and shock are more common. Thrombosis (commonly digital ischemia and gangrene) less often predominates
- Thrombocytopenia, prolonged PT and PTT, elevated D-dimers (most sensitive) and fibrin, decreased fibrinogen and factor V and VIII levels, peripheral smear shows schistocytes. Also microangiopathic hemolytic anemia

34
Q

tx of DIC

A
  • Supportive treatment, correction of underlying disorders PROMPTLY and AGGRESSIVELY
  • Component blood transfusions are important, particularly the replacement of fibrinogen through the administration of cryoprecipitate. The role of heparin is controversial
    `

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