what is in blood?
what are RBC called?
What do RBCs do?
Erythrocytes
carry O2
what is thrombocytopenia?
The body has lower than normal number of plts in blood
less than 150,000
what are the diagnostic studies?
Autoimmune disorder
peripheral blood smear
ITP antigen -specific assay
Medical Hx
clinical examination
Plts below 150,000
What kind of clots are formed?
What organ do those clots affect?
Microthrombi (Tiny blood clots)
Kidney injury!
what complications does HIT cause? (2)
DVT: redness, warmth, edema, tenderness to limb(s)
PE: SOB, tachycardia, chest pain, anxiety
What are WBC called?
What do WBCs do?
Leucocytes
Part of immune system that destroy foreign objects in blood.
Lab values of Plts
150,000 - 450,00
when is therapy initiated?
Initial Tx medications?
SixS of medication?
Corticosteroids (Prednisone:PO) (methylprednisolone: IV)
Kidneys retain Na+ = HTN, Inc. insulin, taper medication to give adrenal glands time to resume usual function, and edema "moon face & buffalo hump"
what plasma enzyme is deficient?
what is the enzymes function?
ADAMTS13 - It is an idiopathic autoimmune disorder against the ADAMTS13
Cuts vWF to prevent clot formation but when there is not enough ADAMTS13 to cut vWF it causes the micro-clots
what to do when patient has HIT?
what to use instead if anticoagulation is still needed?
when to use anticoagulant again when PLT is back up to what value?
STOP HEPARIN!
Warfarin(Coumadin)
150,000
what do platelets do?
stop bleeding by clotting blood
Lab values of RBC
M: 4.5 - 6.5
F: 3.8 - 5.8
Other meds when not responding to steroids?
What do we monitor?
Romiplostim (Nplate) : injection 1x per wk.
Eltrombopag (Promacta): PO 1x daily. (do not consume high Ca foods)
liver damage/ test liver func.= jaundice
routine blood work = increases Plt/inc. clot production
When untreated what does TTP cause?
What needs to be monitored?
irreversible renal failure and death
Urine output
what to do when sever clotting occurs? (4 steps)
Plasmapheresis: clear PLT- agreggating
Protamine Sulfate: interrupt circulating heparin
Thrombolytic: treat thromboembolic event
Surgery: remove clots
what does plasma do?
What does plasma contain?
helps remove waste from body.
transport nutrients, hormones and proteins throughout the body.
contains nutrients (amino acids & glucose)
Lab values of WBC
4,000 - 11,000 (4.0 - 11.0)
when do we initiate PLT transfusion?
<10,000/μL
what is plasmapheresis?
Like dialysis but filters blood plasma.
removes blood and separates blood and plasma, then transfuses back into bloodstream and can replace or add back ADAMTS13
what do we need to avoid?
What do we need to monitor?
Aspirin and IM inj.
FALL PRECAUTIONS, reduce risk of bleeding (soft toothbrushes, safety razors, dab nose, don't blow) monitor PLTs, Hgb &Hct.
what are the causes of thrombocytopenia? (3)
Aquired
Immune thrombocytopenia purpura (ITP)
Thrombotic thrombocytopenia purpura (TTP)
Heparin-induced thrombocytopenia (HIT)
Lab values of Plasma
50 - 55 mL/kg
Last resort if Tx is not responding?
Laparoscopic splenectomy
will cause compromised immune system if removed.
Other Tx options and their order?
Corticosteroids
Rituximab (Rituxin) - reduces # of B cells if plasmapheresis does not work
Immunosuppressants(cyclosporine & cyclophosphamide)
Splenectomy as last resort if immunosuppressants don't work
what are the common terms for cutaneous bleeding? (3)
Petechiae-microhemorrhages (Small pinpoint size red or purple spots)
Purpura-bruising from numerous petechiae
Ecchymosis- full bruising