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19 Cards in this Set

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  • Back
Approach to Thrombocytopenia
1. Labs
2. Determine Etiology
3. Estimate bleeding potential
4. Treat
Thrombocytopenia Labs
Platelet count with different anticoagulant
Peripheral blood smear
Bone Marrow Biopsy
CT scan for spleen size
Etiologies of Thrombocytopenia
Production problems (bone marrow disorders)
Excess consumption/destruction (Immune, DIC, heparin)
Massive transfusion --> dilution
Sequestration/hypersplenism
Thrombocytopenia Treatment
Corticosteroids
Hemophilia
Bleeding problem
Hemarthroses
Get initial platelet plug but no coagulation
X-linked, skips a generation
Prolonged PTT
Factor VIII or IX
Platelet Dysfunction Disorders Labs
Microcytosis
Hypochromia
Normal PLT (but dysfunctional)
Normal PT and PTT
Platelet Dysfunciton Disorders Features
MUCOSAL BLEEDS
-nose bleeds
-heavy menses
Platelet Dysfunction Disorders
von Willebrand's Disease (autosomal dominant)
Asipirin (MI and stroke patients)
von Willebrand's Treatment
DDAVP
stimulates vWF release
Primary Hypercoaguable Conditions
DVT in young patients
Lack proteins to tell coagulation system to stop
-Protein C
-Protein S
-Antithrombin III
-Factor V Leiden
Thrombocytopenia Clinical Features
Low PLT (<140,000)
Fatigue
No bleeding
Hemophilia Clinical Features
Hemarthroses
Family history of bleeding
Normal CBC, PT
Increased PTT
Platelet Dysfunction Clinical Features
Malaise, fatigue, shortness of breath on exertion
Heavy menses, nose bleeds
Spontaneous bruising
Family history
Decreased Hgb, microcytic, hypochromic anemia
Normal PLT
Normal PT and PTT
Hypercoagulability Clinical Features
Pain and swelling
Family history
Spontaneous DVT
Patient presents with fever and shortness of breath.
On CBC, WBC, MCV, and MCH are normal.
Decreased HGB, decreased HCT, increased MCHC, increased RDW, decreased PLT.
Increased neutrophils, decreased lymphocytes, increased metamyelocytes, increased myelocytes.
Reactive changes on biospy.
Schistocytes in PBS.
Leukoerythroblastosis
Neutrophilia with reactive changes
Lymphocytopenia
Normochromic normocytic anemia with microangiopathic changes
Thrombocytopenia
A 65 year old female presents complaining of back pain. On X-ray there are multiple vertebral compression fractures and lytic lesions in the ribs and skull.
Her CBC shows normocytic normochromic anemia.
Her PBS show evidence of rouleaux formations.
Her IgG is increased, but her IgA and IgM are decreased.
Plasma cells make of 60% of blood.
Multiple myeloma
Marrow plasmacytosis > 30%
Serum IgG > 3.5 g/dL
Decreased IgA and IgM
Lytic bone lesions
A 5 year old girl presents with extreme fatigue and easy bruising. On exam, you note pallor, bruising, bleeding gums, and palpable splenomegaly.
Her CBC shows increased WBC, decreased HGB, decreased HCT, decreased MCV, decreased MCH, decreased MCHC, decreased PLT, and increased RDW.
The immunophenotype is CD45+, CD10+, CD20+, CD34+, TdT+
She has a t(12;21).
Precursor B-cell Acute Lymphoblastic Leukemia/Lymphoblastic Lymphoma
A 65 year old female presents complaining of back pain. On X-ray there are multiple vertebral compression fractures and lytic lesions in the ribs and skull.
Her CBC shows normocytic normochromic anemia.
Her PBS show evidence of rouleaux formations.
Her IgG is increased, but her IgA and IgM are decreased.
Plasma cells make of 60% of blood.
Multiple myeloma
Marrow plasmacytosis > 30%
Serum IgG > 3.5 g/dL
Decreased IgA and IgM
Lytic bone lesions
A 5 year old girl presents with extreme fatigue and easy bruising. On exam, you note pallor, bruising, bleeding gums, and palpable splenomegaly.
Her CBC shows increased WBC, decreased HGB, decreased HCT, decreased MCV, decreased MCH, decreased MCHC, decreased PLT, and increased RDW.
The immunophenotype is CD45+, CD10+, CD20+, CD34+, TdT+
She has a t(12;21).
Precursor B-cell Acute Lymphoblastic Leukemia/Lymphoblastic Lymphoma