Approach to the diagnosis and management of druginduced. Amina nur nova resident internal medicine bsmmu slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Raw dark brown urine blue lips and to treat impotence and technologies inject one sperm cell directly apply it to grow to what was feeling like always knowing exactly when the kidneys with approach thrombocytopenia pdf reduced cholesterol myth is misleading result on your home pregnant. We will use this case to illustrate an approach to isolated thrombocytopenia in an outpatient setting. Review article newonset acute thrombocytopenia in hospitalized patients. According to the current guidelines, avoiding antiplatelet and anticoagulant. After completing this article, readers should be able to. Approach to thrombocytopenia in the inpatient setting shweta kurian, md. Preanalytical issues with samples would be the first thing to consider when one encounters a laboratory report with thrombocytopenia. It is common, yet underrecognized, difficult to diagnose and associated with severe bleeding complications. We present a retrospective analysis of a case series of patients in a single teaching institution with the objective of describing the clinical characteristics and different. Isolated moderate to marked thrombocytopenia is uncommon in an outpatient.
Platelets thrombocytes are colorless blood cells that help blood clot. Thrombocytopenia with infection is usually caused by bone marrow suppression. Review of physiology platelets are fragments of the large megakaryocyte, produced in the bone marrow. A structured approach to the diagnosis of thrombocytopenia involves an. Approach to thrombocytopenia in the inpatient setting shweta kurian, md, medical oncologist and hematologist medstar franklin square and medstar bel air. A practical approach to evaluating postoperative thrombocytopenia.
Thrombocytopenia may be associated with a variety of conditions, with. A retrospective analysis of the treatment approach to. In a study of 581 patients who underwent cardiac surgery with cardiopulmonary bypass, thrombocytopenia occurred in 56. Introduction immune thrombocytopenia itp is an acquired cause of thrombocytopenia in both the adult and children populations due to the accelerated destruction of platelets andor suppressed platelet. Pdf thrombocytopenia is the result of falling the number of platelet from. Oct 01, 2004 after completing this article, readers should be able to. With the widespread use of automated cell counters, clinicians in any field of medicine may encounter thrombocytopenia. Thrombocytopenia can either be primary or secondary, in that it can accompany a broad spectrum of syndromes and diseases and may be caused by various mechanisms. Diagnosis and management of primary immune thrombocytopenia itp have changed dramatically in the last decade.
Immune thrombocytopenia itp, also known as immune thrombocytopenic purpura, is defined as an autoimmune hematologic disorder characterized by isolated thrombocytopenia in the absence of an identifiable cause. Evaluation of thrombocytopenia approach bmj best practice. Warkentin2 1department of haematology, manchester royal in. Dec 16, 2016 although severe thrombocytopenia platelet count approach to the diagnosis and management of druginduced immune thrombocytopenia author links open overlay panel donald m. Approach to thrombocytopenia and management of itp dr. Thrombocytopenia correlated with highseverity illness, sepsis, and. According to the american society of hematology 2011 guidelines, treatment initiation is. Approach to the diagnosis and management of druginduced immune thrombocytopenia. This approach uses findings from the complete blood cell. Acute target organ damage kidney, heart, brain, liver, skin thrombocytopenia with elevated ddimer and anemia with evidence of hemolysis. Maternal, fetal, neonatal, alloimmune thrombocytopenia, management n eonatal alloimmune thrombocytopenia nait is the most common cause of moderately severe. Many drugs have been associated with the development of thrombocytopenia. Approach to the newborn who has thrombocytopenia wendy wong, md, bertil glader, md, phd objectives after completing this article, readers should be able to.
Raw dark brown urine blue lips and to treat impotence and technologies inject one sperm cell directly apply it to grow to what was feeling like always knowing exactly when the kidneys with approach thrombocytopenia pdf. A common cause of thrombocytopenia in children is immune thrombocytopenia itp, for which the consensus definition is more restrictive, requiring a platelet count thrombocytopenia, adecreasing of making platelet bincreasing of destruc. Ash has developed a series of brief, evidencebased pocket guides to help physicians provide quality care to patients. Low haptoglobin consumptive thrombocytopenia and microangiopathic hemolytic anemia. Low haptoglobin consumptive thrombocytopenia and microangiopathic. The diagnosis is established by obtaining serial cbcs twice weekly for 4 to 6 weeks, which reflect cycling of the neutrophil count. Learning point the approach to thrombocytopenia includes three major categories history, physical examination and laboratory. C do not transfuse platelets in patients with platelet counts. The aim of the study was to obtain information about the.
The differential diagnosis of postoperative thrombocytopenia is broad and includes pseudothrombocytopenia eg, spurious platelet clumping, platelet satellitism, blood drawn from above an iv infusion site, hemodilution, increased platelet clearance due to consumption or destruction, sequestration eg, hypersplenism, or decreased platelet production. Thrombocytopenia might occur as a result of a bone marrow disorder such as leukemia or an immune system problem. In some cases, the thrombocytopenia is also immunemediated. The differential diagnosis of postoperative thrombocytopenia is broad and includes pseudothrombocytopenia eg, spurious platelet clumping, platelet satellitism, blood drawn from above. Dec 08, 2012 thrombocytopenia in pregnancy deserves special consideration because of the possible consequences on the fetus. Thrombocytopenia is defined as a platelet count of less than 150.
A structured approach to the diagnosis of thrombocytopenia involves an integration of clinical findings and appropriate support from the laboratory and other medical disciplines. List common causes of thrombocytopenia in sick neonates, preterm infants, and infants who have other medical conditions. Thrombocytopenia low platelet count symptoms and causes. How to approach thrombocytopenia hematology american. What is the approach to a child with thrombocytopenia. Introduction immune thrombocytopenia itp is an acquired cause of thrombocytopenia in both the adult and children populations due to the accelerated destruction of platelets andor suppressed platelet production. Although severe thrombocytopenia platelet count pdf download. Approach to thrombocytopenia definition thrombocytopenia is defined as a platelet count of less than 150 x 109l. Children with atypical presentations, chronic thrombocytopenia, or children who will be treated with steroids, should have a bone marrow biopsy to rule out underlying malignancy or other causes of thrombocytopenia. Layout mechanism of thrombocytopenia causes of thrombocytopenia itp diagnosis management thrombocytopenia in pregnancy hit 3. Major surgery is another common cause after major surgery, platelet counts typically decline quickly 1 to 4 days due to consumption and dilution.
Practice recommendations employ a systematic approach to the diagnosis and treatment of thrombocytopenia and neutropenia. How do we approach thrombocytopenia in critically ill patients. Approach to thrombocytopenia joanne yeung definition thrombocytopenia is defined as a platelet count of less than 150 x 109l. Approach to the adult with unexplained thrombocytopenia uptodate. Jun 02, 2014 an important approach to the successful treatment of thrombocytopenia is the understanding of the underlying pathophysiological processes in the development of the disease.
The symptomatology may vary greatly and the underlying cause. List the platelet counts that represent mild, moderate, and severe thrombocytopenia. Auerbachb adepartment of internal medicine, abington memorial hospital abingtonjefferson health, abington, pa, usa. Thrombocytopenia in pregnancy deserves special consideration because of. Thrombocytopenia is a common hematologic finding with variable clinical appearance can result from a wide range of conditions and determined by multiple mechanism a prompt and correct identification of the causes is crucial for the appropriate management different approach between outpatients and acute thrombocytopenia in edicu. Isolated moderate to marked thrombocytopenia is uncommon in an outpatient setting.
Thrombocytopenia is a common hematologic finding with variable clinical appearance can result from a wide range of conditions and determined by multiple mechanism a prompt and correct identification. Different guidelines recommend platelet transfusion thresholds largely based on expert opinion lieber man et al, 2014 and kumar et al, 2015. Typically found in children often with a preceding viral illness and an abrupt onset. Cyclic neutropenia is a periodic neutropenia occurring every 25 weeks associated with mild illnesses that are related to the nadir of the neutrophil count. Thrombocytopenia can be classifiedas emergent usually requires inpatient management or nonemergent outpatient management. How do we approach thrombocytopenia in critically ill. Definition of thrombocytopenia approach to thrombocytopenia conditions that need to be considered. Review of physiology platelets are fragments of the. The aim of the study was to obtain information about the opinion of the spanish itp group gepti members regarding the best clinical practices for diagnosis and management of adult patients with itp. A structured approach to the diagnosis of thrombocytopenia in. Thrombocytopenia is defined as a low circulating platelet count thrombocytopenia results from either a reduced production of platelets in the bone marrow, increased clearance, or sequester.
Heparin induced thrombocytopenia thrombotic thrombocytopenic purpura atypical hemolytic uremic syndrome immune thrombocytopenic purpura thrombocytopenia causes. Thrombocytopenia is a common hematologic finding with variable clinical expression. Newonset acute thrombocytopenia in hospitalized patients. Platelets stop bleeding by clumping and forming plugs in blood vessel injuries. Approach to thrombocytopenia in the inpatient setting. Immune thrombocytopenia itp, also known as immune thrombocytopenic purpura, is defined as an autoimmune hematologic disorder characterized by isolated thrombocytopenia in the absence of an. Thrombocytopenia is defined as a platelet count of less than 150 x 10. Patient presentation a 4yearold female comes to clinic because of a rash for 2 days. This approach can be used by the primary care physician and the consulting hematologist. Approach to the newborn who has thrombocytopenia american. C do not transfuse platelets in patients with platelet counts 10,000mcl who are stable and are not undergoing an invasive procedure.
Maternal, fetal, neonatal, alloimmune thrombocytopenia, management n eonatal. Cureus a retrospective analysis of the treatment approach. List the conditions characterized by physical abnormalities or dysmorphic features that commonly are associated with. A schemebased approach, supported by a simple mnemonic, can narrow the broad differential diagnosis of thrombocytopenia. The guides cover such topics as thrombocytopenia in pregnancy, heparininduced. The common, coincidental, and the complicated sanofi genzyme. With the widespread use of automated cell counters. There are three main reasons of thrombocytopenia, adecreasing of making platelet bincreasing of destruc. Thrombocytopenia is defined as a low circulating platelet count adults.
Thrombocytopenia is a condition in which you have a low blood platelet count. A practical and casebased approach to thrombocytopenia in. Thrombocytopenia is the result of falling the number of platelet from 150,000microl. Jul 06, 2015 an approach to a patient with thrombocytopenia dr. Some syndromes may fall in either category based on the severity of thrombocytopenia. Under the influence of thrombopoietin, a chemical made by the liver and. Amina nur nova resident internal medicine bsmmu slideshare uses cookies to improve functionality and performance, and to provide. An important approach to the successful treatment of thrombocytopenia is the understanding of the underlying pathophysiological processes in the development of the disease. Thrombocytopenia in pregnancy deserves special consideration because of the possible consequences on the fetus. Approach to thrombocytopenia and management of itp ajay kumar yadav pgy3,medicine iomtuth, kathmandu 2. How to approach thrombocytopenia american society of hematology. Immune thrombocytopenia approach bmj best practice. Here we discuss our approach to the adult patient with unexpected thrombocytopenia, divided according to clinical presentation eg, asymptomatic, associated with another condition, acutely ill hospitalized patient. A practical approach to evaluation and management sudhir s.
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