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29 Cards in this Set

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  • Back
What are the 4 criteria for diagnosis of ITP?
1-thrombocytopenia (<150) 2-purpuric rash 3-normal bone marrow 4-absence of signs of other causes of thrombocytopenia
What is chronic ITP?
Thrombocytopenia > 6 months from initial presentation
What age group gets Acute ITP?
Mostly <10 years
In which season does acute ITP occur?
Late winter and spring
What age group gets chronic ITP?
Is there a male/female imbalance in incidence of ITP?
Not for acute ITP, but more females get chronic ITP.
What other illness is associated with ITP?
underlying autoimmune disorder, with up to one third having clinical and laboratory manifestations of collagen-vascular disease.
What happens to number of megakaryocytes in the bone marrow in ITP?
Normal or increased
What happens to plasma thrombopoietin levels in ITP?
Presentation of acute ITP
child develops easy bruising and a purpuric rash, 1/3 with bleeding from mucus membranes; often preceded by a viral illness
Pertinent negatives on exam for ITP
absence of lymphadenopathy, hepatosplenomegaly, pallor, hyperbilirubinemia
What is the distribution of bruises and bleeding sites in ITP?
Generalized, occur in areas not exposed to trauma
What is the usual platelet count in acute ITP?
20-30 x 10 to 9/L
What are the levels of other cell lines in Acute ITP?
Normal or mild anemia due to bleeding
What are the PT and PTT in acute ITP?
What is the bleeding time in acute ITP?
Why must a smear be examined?
rule out "pseudothrombocytopenia,” look for hemolysis, hypoproliferative anemia, r/o bone marrow neoplasm, look for large platelets
What is "pseudothrombocytopenia"
an in vitro artifact caused by the clumping of platelets in tubes containing the anticoagulant EDTA, which results in low platelet counts when measured on an automated cell counter.
What is the usual platelets in chronic ITP?
20-70 x 10 to 9
What other studies are needed?
Thyroid studies, evaluation for autoimmune disease, infection and immunodeficiency, coombs test, retic count
What is Evans syndrome?
Immune thrombocytopenia with autoimmune hemolytic anemia
What immunization may lead to isolated thrombocytopenia?
What studies must be done to rule out autoimmune disease before diagnosing chronic ITP?
Antinuclear antibody, Anti-DNA antibody, Antiphospholipid antibody, Sedimentation rate, Coombs test/reticulocyte count, Thyroid studies (if thyroid disease is suspected)
What viral infections must be ruled out before diagnosing chronic ITP?
HIV, CMV, EPV, Rubella, measles, varicella, mumps, hepatitis
What studies must be done to rule out immunodeficiency before diagnosing chronic ITP?
HIV titer, quantitative immunoglobulins, quantitation of T and B cell subsets
Must a Bone marrow aspiration be done to diagnose ITP?
Not necessarily
What may an ITP patient be treated with prior to a bone marrow study?
What may an ITP patient not be treated with prior to a bone marrow study?
Interferes with the diagnosis of leukemia