Scribd Logo
Upload

Welcome to Scribd!

  • 92 views

    Approach To Thrombocytopenia: Dr. Ahmed Mahdy - Kbim - R4

    Uploaded by

    Ahmed Mahdy
    Thrombocytopenia is defined as a platelet count below 150,000/uL. The document outlines an approach to evaluating and managing thrombocytopenia, including obtaining a history, physical exam, and initial lab tests. If the cause is unclear, further testing may include a hematology consultation and bone marrow examination. Thrombocytopenia can be caused by decreased platelet production, increased platelet destruction, redistribution, or hemodilution. General management principles involve activity restrictions, managing anticoagulants/antiplatelets, and transfusing platelets for procedures or bleeding with severe thrombocytopenia below 50,000/uL.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Approach To Thrombocytopenia: Dr. Ahmed Mahdy - Kbim - R4

    Uploaded by

    Ahmed Mahdy
    92 views23 pages
    Thrombocytopenia is defined as a platelet count below 150,000/uL. The document outlines an approach to evaluating and managing thrombocytopenia, including obtaining a history, physical exam, and initial lab tests. If the cause is unclear, further testing may include a hematology consultation and bone marrow examination. Thrombocytopenia can be caused by decreased platelet production, increased platelet destruction, redistribution, or hemodilution. General management principles involve activity restrictions, managing anticoagulants/antiplatelets, and transfusing platelets for procedures or bleeding with severe thrombocytopenia below 50,000/uL.

    Original Description:

    Approach to thrombocytopenia in the admitted patient

    Original Title

    InPatient Thrombocytopenia

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Thrombocytopenia is defined as a platelet count below 150,000/uL. The document outlines an approach to evaluating and managing thrombocytopenia, including obtaining a history, physical exam, and initial lab tests. If the cause is unclear, further testing may include a hematology consultation and bone marrow examination. Thrombocytopenia can be caused by decreased platelet production, increased platelet destruction, redistribution, or hemodilution. General management principles involve activity restrictions, managing anticoagulants/antiplatelets, and transfusing platelets for procedures or bleeding with severe thrombocytopenia below 50,000/uL.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    92 views23 pages

    Approach To Thrombocytopenia: Dr. Ahmed Mahdy - Kbim - R4

    Uploaded by

    Ahmed Mahdy
    Thrombocytopenia is defined as a platelet count below 150,000/uL. The document outlines an approach to evaluating and managing thrombocytopenia, including obtaining a history, physical exam, and initial lab tests. If the cause is unclear, further testing may include a hematology consultation and bone marrow examination. Thrombocytopenia can be caused by decreased platelet production, increased platelet destruction, redistribution, or hemodilution. General management principles involve activity restrictions, managing anticoagulants/antiplatelets, and transfusing platelets for procedures or bleeding with severe thrombocytopenia below 50,000/uL.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 23

    APPROACH TO

    THROMBOCYTOPENIA
    DR. AHMED MAHDY – KBIM – R4
    OUTLINE
    • Definitions
    • When To Worry
    • Approach to Thrombocytopenia
    • History
    • Physical Exam
    • Lab Investigations
    • Hematology Consultation
    • Bone Marrow Evaluation
    • Causes of Thrombocytopenia
    • General Management Principles
    DEFINITION

    1. Mild: 100 to 150


    2. Moderate: 50 to 100
    3. Severe: < 50

    Keep in mind, these are 95% confidence intervals, so 2.5% of


    population < 150
    WHEN TO WORRY ABOUT BLEEDING

    • Presence of wet purpura


    • Prior Bleeding episode at a similar Plt Number
    • Clinical Judgment is essential to Determine A “safe” Level

    Platelet Number Risk


    <50 Bleeding from General Surgeries
    Bleeding from High Risk Procedures (Neurosurgery, Ocular,
    <100
    Orthopedic, Cardiac)
    <20 (mostly <10) Spontaneous Bleeding
    WHEN TO WORRY ABOUT THROMBOSIS

    • Heparin Induced Thrombocytopenia (HIT)


    • Antiphospholipid Syndrome (APS)
    • Disseminated Intravascular Coagulation
    • Thrombotic Microangiopathy (e.g. TTP or HUS)
    • Paroxysmal Nocturnal Hemoglobinuria (PNH)
    APPROACH TO THROMBOCYTOPENIA

    • History
    • Prior platelet counts
    • Family history of bleeding/thrombosis
    • History of bleeding
    • Drug history
    • Exposure to infections
    • Past medical conditions
    • Diet
    APPROACH TO THROMBOCYTOPENIA

    • Physical Exam
    • Skin and other bleeding sites:
    • Petechia
    • Purpura
    • Ecchymosis
    • Hematuria
    • Malena
    • Liver
    • spleen
    • lymph nodes
    APPROACH TO THROMBOCYTOPENIA

    • Lab Investigations (essential)


    • Repeat CBC
    • Immediately: symptomatic/clinical findings present
    • Non-urgent: asymptomatic/out of context
    • Peripheral blood smear
    • Rule out psuedothrombocytopenia
    • Abnormal WBC/RBC morphology
    • HIV & Hep C
    PERIPHERAL SMEAR IN THROMBOCYTOPENIA
    • Schistocytes: a microangiopathic process (eg, DIC, TTP, HUS).

    • Nucleated RBCs and Howell-Jolly bodies: post-splenectomy or occasionally in patients with poor splenic
    function.

    • Spherocytes: immune-mediated hemolytic anemia or hereditary spherocytosis.

    • Leukoerythroblastic findings, teardrop cells, nucleated RBCs, or immature granulocytes: an infiltrative


    process in the bone marrow.

    • Leukocytosis with a predominance of bands (left shift) or toxic granulations: infection.

    • Immature WBCs (eg, myeloblasts) or dysplastic WBCs: leukemia or myelodysplasia.

    • Multi-lobed/hypersegmented neutrophils (i.e, >5 lobes): a megaloblastic process


    (eg, B12/folate/copper deficiency)
    APPROACH TO THROMBOCYTOPENIA

    • Lab Tests (Others, if indicated)


    • Anti-nuclear antibodies or anti-phospholipid antibodies
    • Hepatic enzymes, albumin
    • PT, aPTT
    • LDH
    • Renal function Tests
    APPROACH TO THROMBOCYTOPENIA

    • Hematology Consultation
    • Urgent:
    • TTP/HUS
    • HIT
    • Malignancy: Acute Leukemia, aplastic Anemia
    • Severe thrombocytopenia: Bleeding, for urgent procedure, pregnancy
    • Elective:
    • confirm any new diagnosis of a thrombocytopenic condition
    • to determine the cause of any unexplained thrombocytopenia after proper
    work-up (e.g. for bone marrow evaluation)
    APPROACH TO THROMBOCYTOPENIA
    • Bone marrow examination (aspirate and biopsy)
    • Cause of thrombocytopenia is unclear
    • Primary hematologic disorder is suspected
    • Findings

    • Normal or increased numbers of megakaryocytes: platelet destruction (eg, ITP, drug-induced immune
    thrombocytopenia)
    • Decreased megakaryocyte numbers, decreased or absent cellularity: aplastic anemia.
    • severe reduction or absence of megakaryocytes: SLE, (an autoantibody directed against the
    thrombopoietin receptor)
    • Megaloblastic changes in the RBC and granulocytic series: nutrient deficiency (eg, vitamin B12,
    folate, copper)
    • Dysplastic changes: myelodysplastic disorder
    • Granulomata, increased reticulin or collagen fibrosis or infiltration with malignant cells: bone
    marrow invasion
    APPROACH TO THROMBOCYTOPENIA
    CAUSES
    Two Main Categories

    1. Decreased production
    • BM failure syndromes (eg, aplastic anaemia, myelodysplastic
    syndromes, and chemotherapy-induced thrombocytopenia)
    2. Increased destruction
    • DIC and the thrombotic microangiopathies; together with platelet
    sequestration and hemodilution less commonly
    CAUSES (CONT’D)
    Bone Marrow Dysfunction
    • MDS
    • Leukemia
    • Paroxysmal Nocturnal Hemoglobinuria
    • Infection
    • Alcoholism
    • Nutritional Deficits
    • ITP (decreased BM production and peripheral destruction)
    • Malignancy (extension into BM)
    CAUSES (CONT’D)
    1. Redistribution
    a. Spleen carries ⅓ of our total body platelet mass
    b. Hypersplenism redistributes this higher (ex: ½)
    c. Total body mass is the same

    2. Hemodilution
    a. Platelet-poor transfusions (PRBC, fluids)
    CAUSES (CONT’D)
    Destruction/Consumption
    • Thrombotic Microangiopathies (TTP, Hus, DIC)
    • Immune Thrombocytopenia
    • Drug-Induced Thrombocytopenia
    • Evan’s Syndrome
    • Heparin Induced Thrombocytopenia
    DRUG INDUCED THROMBOCYTOPENIA (DIT)
    Drug-induced Thrombocytopenia typically presenting 5-7 days after exposure to the causative agent, and resolving
    between 7- 14 days after drug discontinuation.

    • Penicillins
    • Carbamazepine
    • Gold compounds
    • Heparin
    • Phenytoin
    • Rifampin
    • Sulfonamides
    • Linezolid
    • Vancomycin
    • Valproic Acid
    • Etc…
    GENERAL MANAGEMENT PRINCIPLES
    • Activity restrictions: 
    • moderate to severe thrombocytopenia (<50,000/microL) generally should not participate in
    extreme athletics such as boxing, rugby, and martial arts.
    • Management of Anticoagulant and anti-platelet medications 
    • Prophylactic anticoagulation at 30,000 or above
    • Theraputic Anticoagulation requires higher figures (50,000)
    • Over-the-counter drugs:
    • Caution with drugs interfering with platelet function (eg, aspirin, non-steroidal anti-
    inflammatory drugs, ginkgo biloba).
    • Safe platelet count for invasive procedures 
    • Emergency management of bleeding 
    • bleeding with severe thrombocytopenia requires immediate platelet transfusion, regardless
    of the underlying cause.
    WHEN TO TRANSFUSE?
    THANKS FOR LISTENING

    You might also like