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28 Cards in this Set
- Front
- Back
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THROMBOCYTOPENIA
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primary
idiopathic secondary: infectious neoplasia |
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throbocytopenia
disorders of production: |
BM disease
extrogen myeloproliferative dz-using up space in marrow erlichia live viruses |
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diorders of distribution
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spleen sequestration
hypersplenisms: storage/destruction liver disease |
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disorders of utilization
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DIC
chronic hemorrage |
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disorders of destruction
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immune
infectious |
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Dx of throbocytopenia
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-unopipette system
-estimation on well made smear 10-15/hpf OI= 1/20RBC:high dry 40x check feathered edge for clumps to make sure not spuriuos decrease Morphology:rapid turnover -large platelts -fragmented platelets:ITP |
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Signalment
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DOG
mature females mor than males Breeds: cocker, German SHeps, min poodles Cats: |
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King Charles cavalier spaniels
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have low platelt counts
no problem |
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Mechs of ITP
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-specific Anti-platelt Ab
-Ab agnst hapten-platelet membrane comples -passive absorption Ag-Ab onto pletelet |
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Clinical ITP forms
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Acute/severe
chronic recurrent drug induced |
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Drugs that induce ITP
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heparin
methamizole Sulfa drugs acepromazine thiazides estrogens |
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infectious disorders causing ITP
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leishmania
babesia do titers based on potential exposure |
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ITP
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VERY low platelet counts
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clinical signs
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hemorrage
dogs bleed when platelets below 50K cats bleed with less Secondary anemia decreased platelets lead to decreased vascular integrity DONT PUT ON ASPIRIN IF PLATELETS LESS THEN 10,000 bleeding tendencies may appear discordant with platelt counts -petechia dn echymosses bleeding from orifices uncommon: hepatomegaly, lymphadenopathy, fever |
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clinical signs requiring immediate blood transfusion
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CNS signs
ocular bleeding need STAT blood packed cells wont help need fresh blood donor |
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prob with jug blood collection with ITP dog
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can bleed into mediastinum
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always do rectal exam on suspect
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may be bleeding into GIT tract
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rs for bleeding
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OPTIMAL_fresh whole blood
NOT: packed cells platelet concentrates-way too reactive, last for an hour, way expensive oxyglobin |
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Definitive diagnosis
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have to take blood and urine
DONT: jug arteriolar catherize urethra cysto BMBT way too dangerous if you cant pressure wrap-dont do it minimize venipuncture/catheters |
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diagnostic testing:
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CBC
platelet count reticulocyts coombs clotting tesst ITP-most severe thrombocytopenia DIC<5000 infectious diseases dont you get this low |
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diagnostics-less common
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BM biopsy
Platelet factor 3-unreliable Platelet flow cytometry |
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Tx
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contol bleeding
reestablish platelet counts eliminate underlying disease Transfustion: |
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platelet rich plasma
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IMPrACTICAL
very $$$ platelets may not react normally-hyperaggregating-use too fast |
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Tx.
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glucocorticoids
-pred platelet count rises within 4 days gastroprotectant b/c of steroids cytotoxic tx. if steroids dont work |
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cytotoxics
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avoid cytoxin!!!
AZO cylcosporin danazol VINCRISTINE IS BEST |
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vincristine
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binds tubulin
tubulin is in platelets Injectable very irritating if given outside vein-MAKE SURE IN VEIN give slowly mix it up, give over a couple of hours because it gloms onto tubulin in platelets, Kill macrophage population that engulfs platelets want longer duration for vincristine to bind platelets cover bag in tubing to protect it from light can make big differences in couple of days weekly for 2-3 weeks low dose too high dose you'll kill marrow use good catherter, flush catherter after |
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toxicty of Vincristin
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BM myelosuppression
Syndrome of innapropriate ADH-look overhydrated 4 days post Tx-dont freak--careful with fluids chemotherapy drug vesicant |
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ITP Tx best
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splenectomy
-rapid remission -will have to give whole blood -always check marrow before you take speen out cuz spllen can do extramedullary hematopoiesis |
