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19 Cards in this Set
- Front
- Back
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Approach to Thrombocytopenia
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1. Labs
2. Determine Etiology 3. Estimate bleeding potential 4. Treat |
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Thrombocytopenia Labs
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Platelet count with different anticoagulant
Peripheral blood smear Bone Marrow Biopsy CT scan for spleen size |
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Etiologies of Thrombocytopenia
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Production problems (bone marrow disorders)
Excess consumption/destruction (Immune, DIC, heparin) Massive transfusion --> dilution Sequestration/hypersplenism |
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Thrombocytopenia Treatment
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Corticosteroids
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Hemophilia
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Bleeding problem
Hemarthroses Get initial platelet plug but no coagulation X-linked, skips a generation Prolonged PTT Factor VIII or IX |
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Platelet Dysfunction Disorders Labs
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Microcytosis
Hypochromia Normal PLT (but dysfunctional) Normal PT and PTT |
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Platelet Dysfunciton Disorders Features
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MUCOSAL BLEEDS
-nose bleeds -heavy menses |
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Platelet Dysfunction Disorders
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von Willebrand's Disease (autosomal dominant)
Asipirin (MI and stroke patients) |
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von Willebrand's Treatment
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DDAVP
stimulates vWF release |
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Primary Hypercoaguable Conditions
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DVT in young patients
Lack proteins to tell coagulation system to stop -Protein C -Protein S -Antithrombin III -Factor V Leiden |
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Thrombocytopenia Clinical Features
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Low PLT (<140,000)
Fatigue No bleeding |
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Hemophilia Clinical Features
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Hemarthroses
Family history of bleeding Normal CBC, PT Increased PTT |
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Platelet Dysfunction Clinical Features
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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 |
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Hypercoagulability Clinical Features
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Pain and swelling
Family history Spontaneous DVT |
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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 |
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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 |
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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
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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 |
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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
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