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