UW thrombocytopenia in pregnancy dif. 02-13 (1)

Question 1

Gestational. PLT? symptoms? Dx made?

Answer 1

isolated, mild (100-150k)
asymptomatic
diagnosis of exclusion (pvz pirmam trimestre norma, treciam decr. plt)

Question 2

isolated, mild (100-150k)
asymptomatic
diagnosis of exclusion?

Answer 2

Gestational.

Question 3

Preeclampsia with severe features/hellp syndrome. PLT? symptoms? labs?

Answer 3

moderate to severe (PLT < 100k)
HTN +/-headache/scotomata
+/- incr. Cr, incr. AST and ALT

Question 4

moderate to severe (PLT < 100k)
HTN +/-headache/scotomata
+/- incr. Cr, incr. AST and ALT?

Answer 4

Preeclampsia with severe features/hellp syndrome.

Question 5

Immune-mediated trombocytopenia (ITP). PLT? symptoms? hematologic labs?

Answer 5

isolated, moderate to severe (plt <100k)
Asymptomatic or musocal bleesing/bruising
normal PT and aPTT

Question 6

isolated, moderate to severe (plt <100k)
Asymptomatic or musocal bleesing/bruising
normal PT and aPTT?

Answer 6

Immune-mediated trombocytopenia (ITP).

Question 7

thrombotic thrombocytopenic purpura (TTP). PLT? symptoms? hematologic labs?

Answer 7

severe (Plt <30k)
neurologic symptoms (eg confusion, seizure), fever, abdominal pain, petechiae
normal PT, aPTT

Question 8

severe (Plt <30k)
neurologic symptoms (eg confusion, seizure), fever, abdominal pain, petechiae
normal PT, aPTT?

Answer 8

thrombotic thrombocytopenic purpura (TTP).

Question 9

DIC. plt? symptoms? coagulation?

Answer 9

moderate to severe (<100k)
bleeding (oozing iv sites) +/- thrombosis
incr. PT, incr. aPTT, decr. fibrinogen

Question 10

moderate to severe (<100k)
bleeding (oozing iv sites) +/- thrombosis
incr. PT, incr. aPTT, decr. fibrinogen?

Answer 10

DIC

Question 11

gestational is benign, occurs in 5-10 proc. mechanism?

Answer 11

due to physiologic increases in plasma volume during pregnancy (ie, dilutional effect).

Question 12

when gestational commonly diagnosed?

Answer 12

third trimester on a routine complete blood count

but can arise in first trimester.

Question 13

symptoms in gestational?

Answer 13

Patients are asymptomatic (ie, no bruising, bleeding, or anemia)

Question 14

what are normal physiologic symptoms in gestational thrombocytopenia?

Answer 14

patient’s fatigue, shortness of breath, and symmetric leg swelling.

Question 15

gestational thrombocytopenia - asymptomatic, benign. Mx?

Answer 15

reassurance and observation.

does not affect outcomes, normalizes after 6 weeks

Question 16

gestational thrombocytopenia. if symptomatic OR moderate-severe (<100k), Mx?

Answer 16

requires evaluation for an alternate diagnosis (eg, thrombotic thrombocytopenic purpura).

Question 17

when do 24h urine protein?

Answer 17

to evaluate for preeclampsia.
But has: HTN >140/90, plt<100

Question 18

Antinuclear antibody titers for what?

Answer 18

elevated in autoimmune disorders (eg, systemic lupus erythematosus) –> which assoc. with ITP. But PLT <100k.

Question 19

when do coagulation studies?

Answer 19

thrombocytopenia with abnormal bleeding or clotting (eg DIC)

Question 20

vWD? labs’?

Answer 20

patients typically have abnormal bleeding and normal platelet levels