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23 Cards in this Set
- Front
- Back
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238. What does ITP (Immune Thrombocytopenic Purpura) result from pathophysiologically?
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a. Autoimmune antibody formation against host platelets.
b. These antiplatelet antibodies (IgG) coat and damage platelets, which are then removed by splenic macs c. (reticuloendothelial system binds self-immunoglobulins attached to platelets) |
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239. Type of antibodies in ITP?
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a. antiplatelet antibodies (IgG)
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240. 2 forms of ITP and who are each form seen in?
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1. Acute form- Children
2. Chronic form- Adults |
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241. What is the acute form (children) of ITP preceded by in most cases?
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a. Viral infection.
b. Usually self-limited- 80% resolve spontaneously w/I 6 months. |
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242. Chronic form of ITP (Adults)?
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a. Most often in women between 20-40 yrs old.
b. Spontaneous remissions are rare. |
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243. Clinical features of ITP?
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a. Petechiae and ecchymoses on the skin
b. Bleeding of the mucous membranes c. NOOOOO Splenomegaly. ITP= I do not have splenomegaly. |
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244. Diagnosis of ITP (5 things)
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1. Platelet count is frequently < 20,000.
2. The remainder of blood count is normal (unless significant bleeding has occurred, in which case the Hb/Hct is ↓’d and retic count is ↑’d. 3. Peripheral smear shows ↓’d platelets. 4. Bone marrow aspiration; shows ↑’d megakaryocytes 5. There is an ↑’d amount of platelet-associated IgG. |
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245. Associated risk in thrombocytopenia if platelet count >100,000?
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a. Abnormal bleeding (even after trauma or surg) is unusual.
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246. Associated risk in thrombocytopenia if platelet count 20,000-70,000?
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a. ↑’d bleeding haemorrhage during surgery or trauma.
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247. Associated risk in thrombocytopenia if platelet count <20,000?
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a. Minor spontaneous bleeding
b. Easy bruising, petechiae, epistaxis, menorrhagia, bleeding gums. |
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248. Associated risk in thrombocytopenia if platelet count <5,000?
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a. Major spontaneous bleeding
b. Intracranial bleeding c. Heavy GI bleeding |
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249. HIT type 1 pathophys?
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a. Heparin directly causes platelet aggregation.
b. Seen <48 hours after initiating heparin. c. No tx is needed. |
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250. HIT type 2 pathophys, when is it seen, and treatment?
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a. Heparin induces antibody-mediated injury to platelet.
b. Seen 3-12 days after initiating heparin. c. Heparin should be D/C’d immediately. |
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251. Treatment of ITP??!?!?
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a. Adrenal corticosteroids.
b. IVIG- saturates the reticuloendothelial system binding sites for platelet-bound self-immunoglobulin, so there is less platelet uptake and destruction by the spleen. c. Splenectomy- Induces remission in 70-80% of cases of chronic ITP. |
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252. Tx of ITP for life-threatening and serious haemorrhagic episodes?
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a. Platelet transfusions.
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253. Pathophys of TTP (Thrombotic Thrombocytopenic Purpura (TTP)?
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a. TTP is a rare disorder of platelet consumption. Cause is unknown.
b. Hyaline microthrombi (mostly platelet thrombi) occlude small vessels- any organ may be involved. i. They cause mechanical damage to RBCs (schistocytes on peripheral smear). |
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254. Is TTP a serious condition?
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a. YES. It is a life-threatening emergency that is responsive to therapy. If untreated, death occurs w/in a few months.
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255. 5 must-know features of TTP?
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1. Haemolytic anaemia (Microangiopathic)
2. Thrombocytopenia 3. Acute renal failure 4. Fever 5. Fluctuating, transient neurologic signs- can range from mental status change to hemiplegia. |
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256. Tx of TTP?!?!?
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a. Plasmapheresis (large volume)
i. Begin as soon as diagnosis is established (delay in tx is life-threatening). ii. Response is usually good (monitor platelet count, which should increase) b. Steroids and splenectomy – may be of benefit in some cases. |
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257. Are platelet transfusions used for TTP?
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a. NOO, Contraindicated.
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258. PT and PTT in TTP?
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a. Normal!!! There is no consumption of clotting factors.
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259. How does TTP compare to HUS?
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a. TTP = HUS + Fever + Altered mental status.
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260. HUS?
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a. Microangiopathic haemolytic anaemia + thrombocytopenia +renal failure.
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