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Transcript of Thrombocytopenia
Diagnosis of ITP
Only two criteria are required for its diagnosis :
Thrombocytopenia, with an otherwise normal CBC and WBC differential, including a normal peripheral blood smear
No clinically apparent associated condition(s) or medications that may cause thrombocytopenia are present.
Approach to Thrombocytopenia
Ending with Diagnosis of ITP
Normal 150,000 to 450,000/microL
2.5% have lower than normal
new meds, illnesses ect
- look for:
occular fundus for evidence of bleeding
Stool for occult blood
CBC + peripheral Smear
BM biopsy/HIV testing
Even if in normal range if platelet count drops 50% within 5-10 days of starting heparin think HIT
Obviously immediately stop Heparin
If no contraindications immediately start alternative non-heparin (or warfarin) anticoagulant
Clinical or spontaneous -bleeding
<10,000 to 20,000/microL.
Spontaneous life threatening bleeding
Validate the platelet count!
Clotting of blood
acquired- aplastic anemia
congenital- Fanconi's syndrome
tumors, leukemia, fibrosis
Vit B12/folate deficiency
After viral infecion
Immune Thrombocytopenic Purpura
Heparin Induced Thrombocytopenia T1
Disseminated Intravascular Coagulation
Thrombotic Throbocytopenic Purpura
Most Common Drugs
Quinine and quinidine
Trimethoprim-sulfamethoxazole and other sulfonamides
Glycoprotein IIb/IIIa inhibitors (eg, abciximab)
You've got Nothin'
Autoimmune antibody (IgG) formation against host platelets. IgG coats and damages platelets which are then removed by splenic macrophages
, these antibodies are not easily demonstrable in all patients, and assays for antiplatelet antibodies have not been important for management decisions.
Types of ITP
if it has no underlying cause
if it is immune mediated but associated with an underlying disorder
has lasted for more than 12 months
if it has failed to respond to (or relapsed after) splenectomy and is severe (ie, associated with bleeding or bleeding risk that requires therapy).
Petechiae and ecchymosis on the skin but many patients will have minimal bleeding symptoms despite extremely low platelet counts (<5,000)
Bleeding of mucous membranes
Platelet count typically
Other blood count
BM aspiration shows
Increased amount of
IVIG may be used instead of glucocorticoids when a more rapid increase in platelet count is required
Induces Remission in 70-80% of Chronic ITP cases
Thrombopoietin receptor agonists:
**Platelet transfusions for life threatening and serious hemorrhagic episodes
**Avoid unnecessary treatment of asymptomatic patients with mild to moderate thrombocytopenia!!
When to worry about bleeding?
---Callie Davies MSIII---