Thrombocytopenia and Related Disorders

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Questions and Answers

What platelet count level is considered thrombocytopenia?

150-200 x 10^9/L

Less than 150 x 10^9/L (correct)

50-100 x 10^9/L

100-150 x 10^9/L

Which of the following is a common clinical manifestation of thrombocytopenia?

Elevated bilirubin levels

Deep vein thrombosis

Spontaneous petechiae (correct)

Transient ischemic attack

What is the primary cause of Heparin-Induced Thrombocytopenia (HIT)?

Low levels of Vitamin K

Viral infections causing clotting

IgG antibodies destroying platelets (correct)

Overproduction of platelets

What is the treatment for thrombocythemia?

Administration of anticoagulants Signup and view all the answers

What is considered a major spontaneous bleeding threshold in thrombocytopenia?

Less than 20 x 10^9/L Signup and view all the answers

What is a primary cause of impaired hemostasis?

Defects or deficiencies in clotting factors Signup and view all the answers

Which of the following conditions can lead to the development of Disseminated Intravascular Coagulation (DIC)?

Liver failure Signup and view all the answers

What is a common sign associated with Disseminated Intravascular Coagulation (DIC)?

Symmetrical cyanosis of the fingers and toes Signup and view all the answers

Which of the following best describes Idiopathic Thrombocytopenic Purpura (ITP)?

A form of thrombocytopenia due to immunologic platelet destruction Signup and view all the answers

What is the primary focus of treating Disseminated Intravascular Coagulation (DIC)?

Maintain organ function and correct the underlying cause Signup and view all the answers

Which of the following best describes the primary characteristic of multiple myeloma?

Malignant proliferation of plasma cells Signup and view all the answers

What is a common treatment approach for managing multiple myeloma?

Chemotherapy and radiation Signup and view all the answers

What condition is characterized by the enlargement of the spleen due to being overfilled with blood?

Congestive splenomegaly Signup and view all the answers

How is multiple myeloma typically diagnosed?

Urinalysis for Bence Jones protein Signup and view all the answers

Which of the following is NOT a function of the spleen?

Digestive enzyme production Signup and view all the answers

What is a common early symptom of vitamin B12 deficiency?

Nonspecific and vague symptoms Signup and view all the answers

What characterizes microcytic-hypochromic anemias?

Decreased oxygen carrying ability Signup and view all the answers

Which of the following is a symptom associated with sideroblastic anemia?

Shortness of breath Signup and view all the answers

What condition is characterized by an inability to generate mature blood cells?

Aplastic Anemia Signup and view all the answers

What is a known consequence of Polycythemia Vera?

Hypercoagulability Signup and view all the answers

Which disorder results in an overload of iron and requires dietary management?

Hereditary Hemochromatosis Signup and view all the answers

What term describes a low white blood cell count?

-penia Signup and view all the answers

Which of the following is NOT a symptom of iron deficiency anemia?

Jaundice Signup and view all the answers

What is the primary cause of Infectious Mononucleosis?

Epstein-Barr virus Signup and view all the answers

Which diagnostic test is used to confirm Infectious Mononucleosis?

Monospot qualitative test Signup and view all the answers

What condition is characterized by an irregular production of white blood cells obstructing bone marrow?

Leukemia Signup and view all the answers

What is the treatment approach for Hodgkin’s Lymphoma?

Chemotherapy, radiation, and surgery Signup and view all the answers

What is a common symptom of Leukemia?

Fever Signup and view all the answers

Which type of lymphoma involves the presence of Reed-Sternberg cells?

Hodgkin’s Lymphoma Signup and view all the answers

What typically causes neutropenia?

Malignant disorders Signup and view all the answers

Which of the following statements about Non-Hodgkin's Lymphoma is true?

It is linked to chromosome translocations. Signup and view all the answers

What is a common cause of anemia related to red blood cell production?

Blood loss Signup and view all the answers

Which term describes the size of red blood cells?

-cytic Signup and view all the answers

What is a primary alteration observed in anemia?

Reduced oxygen carrying capacity Signup and view all the answers

What is the defining characteristic of Macrocytic-Normochromic Anemia?

Large stem cells that lead to unusually large red blood cells Signup and view all the answers

What is a typical symptom of anemia?

Fatigue Signup and view all the answers

What condition may result from vitamin B12 deficiency in relation to Macrocytic-Normochromic Anemia?

Defective red blood cells that die prematurely Signup and view all the answers

Which condition is specifically related to the absence of intrinsic factor?

Pernicious Anemia Signup and view all the answers

What is the primary treatment goal for managing anemia?

Relieve symptoms and address the underlying condition Signup and view all the answers

Study Notes

Hematological Function Alterations

Thrombocytopenia:
- Normal platelet count: 150-400 x 10⁹/L
- <150 platelets/µL = thrombocytopenia
- <100 platelets/µL = usually asymptomatic
- <20 platelets/µL = spontaneous major bleeding episodes
- Causes: hypersplenism, autoimmune disease, hypothermia, viral/bacterial infections, DIC (disseminated intravascular coagulation)
- Clinical manifestations: petechiae, purpura, bleeding from GI tract (melena), bleeding from urinary tract (hematuria), bleeding from pulmonary mucosa (hemoptysis), bleeding from gums
- Treatment: correct underlying cause, platelet transfusion
Heparin-Induced Thrombocytopenia (HIT):
- Adverse reaction to heparin (usually IV heparin, but may occur with LMWH)
- Immune-mediated: IgG antibodies destroy platelets
- Clinical manifestations: venous and arterial thrombosis
- Lab values: PTT (partial thromboplastin time) for heparin, INR (international normalized ratio) for warfarin
Thrombocythemia:
- Platelet count >400 x 10⁹/L
- Causes:
  - Primary: overproduction of megakaryocytes
  - Secondary: splenectomy
Disorders of Coagulation (Impaired Hemostasis):
- Usually caused by defects or deficiencies in clotting factors.
- Some are inherited (e.g., hemophilia, von Willebrand disease).
- Acquired defects: deficient synthesis of clotting factors by the liver (e.g., liver disease) or dietary deficiency of vitamin K (e.g., insufficient intake of green leafy vegetables).
- Consumptive thrombohemorrhagic disorders involve both hemorrhagic and thrombotic pathological findings.
- Disseminated Intravascular Coagulation (DIC): a complex, acquired disorder with simultaneous clotting and hemorrhage. Damage to vascular endothelium leads to clots, blocking blood flow to organs, and consumption of platelets, exacerbating the bleeding. Etiology includes sepsis, pregnancy complications, infections, trauma, liver disease, hypoxia. -Symptoms include: bleeding from venipuncture sites and arterial lines, purpura, petechiae, and hematomas, symmetrical cyanosis of fingers and toes, and hypovolemic shock
- Treatment: correct the underlying cause, control ongoing thrombosis, and maintain organ function

Other Hematological Disorders

Idiopathic Thrombocytopenic Purpura (ITP):
- Thrombocytopenia resulting from immunological platelet destruction.
- Can be acute (following viral infection) or chronic (linked with immunological disorders).
- Symptoms associated with decreased platelets.
- Diagnostic tests: platelet count, bone marrow study.
- Treatment: IVIg (intravenous immunoglobulin) infusion to suppress anti-platelet antibodies.
Erythrocyte Deficiencies (Anemia):
- Reduction in the total number of RBCs or decrease in hemoglobin quality or quantity.
- Causes: impaired RBC production, blood loss (acute or chronic), or increased RBC destruction.
- Classified by cause or changes in RBC size/shape/hemoglobin content

Clinical Manifestations & Treatment of Anemias

Main alteration is reduced oxygen carrying capacity, leading to tissue hypoxia (low oxygen levels in the blood). This can lead to heart failure, respiratory symptoms, and impaired healing.
Classic anemia symptoms: fatigue, weakness, dyspnea, pallor (reduced hemoglobin).
Types of anemia: Macrocytic-Normochromic, Microcytic-Hypochromic, Sideroblastic, Normocytic-Normochromic, Pernicious Anemia. Treatment depends on the cause and type.
Macrocytic-Normochromic Anemias:
- Large stem cells in the bone marrow mature into unusually large RBCs.
- Ineffective DNA synthesis in RBCs, caused by vitamin B12 deficiencies, leading to premature death of RBCs (eryptosis). This results in the release of bilirubin which can lead to jaundice.
Pernicious Anemia:
- Absence of intrinsic factor required for the absorption of dietary B12 due to autoimmune gastritis. May also be secondary to previous H. pylori infection.
Microcytic-Hypochromic Anemias:
- Characterized by abnormally small RBCs with reduced hemoglobin content (less colour than normal).
Sideroblastic Anemia:
- Insufficient iron uptake. Abnormal hemoglobin synthesis.
Normocytic-Normochromic Anemias:
- RBCs are relatively normal in size and hemoglobin content but insufficient in number.
- Caused by aplastic anemia (inability to generate mature blood cells).

Erythrocyte Excess (Polycythemia)

Polycythemia: excessive RBC production, either relatively (caused by an underlying condition) or absolutely (polycythemia vera).
Polycythemia Vera: Abnormal proliferation of bone marrow stem cells, causing hypercoagulability (increased tendency to form blood clots). Cause is unknown.

Iron Excess (Hereditary Hemochromatosis):

Iron overload, in which the body builds up too much iron in organs and tissues, leading to tissue damage. S/S: Fatigue, malaise, abdominal pain, hepatomegaly, abnormal liver enzymes, and cardiomegaly
Treatment: dietary management (e.g., reduced red meat intake).

Alterations of Leukocyte Function

Leukocytosis: high white blood cell (WBC) count, often due to infection.
Leukopenia: low WBC count, predisposing to infections.
-philia: increased numbers of a specific cell type (e.g., neutrophilia, eosinophilia).
-penia: decreased numbers of a specific cell type (e.g., neutropenia, lymphopenia)

Infectious Mononucleosis ("Mono")

Acute, self-limiting infection of B-lymphocytes, commonly caused by the Epstein-Barr virus (EBV).
Symptoms: fever, sore throat, swollen cervical lymph nodes, increased lymphocyte count.
Serious complications are rare (splenic rupture).
Diagnostic test: Monospot.
Treatment: supportive care with rest, analgesics, and antipyretics.

Leukemias

Malignant disorder of the blood, characterized by irregular WBC production interfering with hematopoiesis.
Pancytopenia (low RBC, platelets, WBC) common.
Acute vs. chronic (based on cell maturation at disease onset).
Myelogenous vs. lymphocytic (based on cell type involved).
Symptoms include: anemia, bleeding (petechiae, purpura), infection, weight loss, bone pain, elevated uric acid, liver, spleen, and lymph node enlargement
Treatment: Chemotherapy, supportive management (e.g., blood transfusions, antibiotics), stem cell transplants.

Lymphadenopathy

Enlarged lymph nodes that become palpable and tender.
Local lymphadenopathy: drainage of an area associated with infection or inflammation.
General lymphadenopathy: occurs in the presence of malignant or nonmalignant disease. This is a relevant finding in Hodgkin's & Non-Hodgkin's lymphomas

Hodgkin's Lymphoma

Characterized by the presence of Reed-Sternberg cells.
Physical findings: adenopathy, mediastinal mass, splenomegaly, abdominal mass.
Symptoms: fever, weight loss, night sweats, pruritus.
Treatment: Chemotherapy, Radiation, and Surgery.

Non-Hodgkin's Lymphoma

Diverse group of lymphomas based on cell types (T, B, NK).
Linked to chromosome translocations.
Risk factors include age, gender, immune disorders, HIV/AIDS, certain viruses, diet.
Symptoms: multiple swollen peripheral lymph nodes, fatigue, weakness, fever, hepatomegaly, splenomegaly.
Treatment depends on cell type; usually chemotherapy and radiation.

Multiple Myeloma

Malignant proliferation of plasma cells infiltrating bone marrow, forming tumor masses in the skeletal system.
Symptoms: skeletal pain, advancing to osteoporosis, hypercalcemia, spinal cord compression, pancytopenia, renal failure.
Diagnosis: bone marrow biopsy, immunoglobulin levels (M protein), x-ray (bone erosion), Bence Jones protein (urine test).
Treatment: Chemotherapy, bone-protective medications, radiation therapy, pain management.

Alterations of Splenic Function

Splenomegaly: enlarged spleen, often an early sign of an underlying condition.
Overfilled with Blood: susceptible to rupture. Congestive splenomegaly linked to ascites, portal hypertension, esophageal varices in hepatic cirrhosis.
Hypersplenism: overactive splenic function. This leads to cytopenias (low blood counts).
Treatment: Splenectomy (surgical removal of the spleen) is an option in some cases.

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Description

This quiz covers critical aspects of thrombocytopenia, including its causes, symptoms, and treatment options. Additionally, it explores related conditions such as Disseminated Intravascular Coagulation (DIC) and multiple myeloma. Test your knowledge on platelet disorders and their clinical manifestations.