Types of thrombocytopenia

Question 1

Causes of thrombocytopaenia

Answer 1

• marrow disorders decreasing production, e.g. malignancy, viral infection, fibrosis
• increased platelet clearance - ITP, TTP, DIC
• sequestration, dilutional, genetic

Question 2

Immune thrombocytopenic purpura definition

Answer 2

• immune destruction of platelets causes macrophages to prematurely remove them from circulation, decreasing platelet lifespan from 10 days to a few hours

Question 3

Immune thrombocytopenic purpura causes

Answer 3

• secondary to hep C, HIV, H pylori, CLL, Hodgkin’s lymphoma, autoimmune haemolytic anaemia
• risk factors - women of childbearing age or age under 10/over 65

Question 4

Immune thrombocytopenic purpura presentation

Answer 4

• bruising
• petechiae
• epistaxis
• oral blood blisters (wet petechiae)
• intracranial haemorrhage (very rare)

Question 5

Immune thrombocytopenic purpura investigations

Answer 5

• FBC shows low platelets
• platelets may be large

Question 6

Immune thrombocytopenic purpura management

Answer 6

• often resolves spontaneously in children
• oral corticosteroid first line
• IVIG or anti-D immunoglobulin
• give platelet transfusion in major bleeding

Question 7

Disseminated intravascular coagulation definition

Answer 7

• excessive and inappropriate activation of the coagulation pathway, which leads to the consumption of platelets and coagulation factors

Question 8

Disseminated intravascular coagulation risk factors

Answer 8

• sepsis
• acute promyelocytic leukaemia
• obstetric complications (amniotic fluid embolism, placental abruption, pre-eclampsia)
• trauma
• malignancy

Question 9

Disseminated intravascular coagulation presentation

Answer 9

• oozing blood from venepuncture sites and wounds
• bleeding from gastrointestinal/ urogenital tract
• thrombus formation in the skin, brain, kidneys and distal circulation (gangrene of fingers and toes)

Question 10

Disseminated intravascular coagulation investigations