Thrombocytopenia
Haematology
ITP (Immune ThrombocytoPenia) (name changed as recognised immune, and can have no purpura)
Ix
FBE
Coags
CTB if headache/concerns about ICH
Rx
<30: Restrict risky activity
Avoid anticoagulants/ antiplatelets: NSAIDs (Aspirin, ibuprofen)
If heavy period > progesterone pill
Watchful waiting if isolated skin involvement regardless of platelets
Rx as per table below
TTP
DIC
Causes
Alloimmune thrombocytopenia (neonatal)
Thrombocytopenia absent radius (neonatal)
Wiskott-Aldrich syndrome (with eczema and thrombocytopenia)
ITP (Immune ThrombocytoPenia) (name changed as recognised immune, and can have no purpura)
- Plt <100, normal Hb/WC
- usually viral trigger
- only 3% have severe bleeding (risk of 0.9% if present without severe bleeding, 0.5% severe ICH)
- usually self resolves in 3 months (60%)
- persistant ITP = 3-12m
- chronic ITP = >12m
- Primary V Secondary (need to investigate to establish)
Ix
FBE
Coags
CTB if headache/concerns about ICH
Rx
<30: Restrict risky activity
Avoid anticoagulants/ antiplatelets: NSAIDs (Aspirin, ibuprofen)
If heavy period > progesterone pill
Watchful waiting if isolated skin involvement regardless of platelets
Rx as per table below
- Steroids
- IVIG if require rapid rise (or AntiD if Rh pos and no splenectomy)
- Platelets if life threatening
TTP
DIC
- systemic exposure to procoagulants
- Fibrin formation (massive > consumption > coagulopathy
- Fibrinolysis > fibrin in microcirculation
- Vaso-occlusion > ischaemia / haemolysis > hypoxia
Causes
- Sepsis
- Tissue trauma: crush injury, massive burns, extensive surgery, severe hypothermia, heat exhaustion, shock
- Leukemia
- Acute haemolytic transfusion reactions
- Kasabach Merritt (KM) syndrome: Kaposiform haemangioendothelioma (giant haemangioma)
- Snake / Spider bites
- Reye's syndrome
Alloimmune thrombocytopenia (neonatal)
Thrombocytopenia absent radius (neonatal)
Wiskott-Aldrich syndrome (with eczema and thrombocytopenia)