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Increased Platelet Destruction


Presentation

  • Written for a multidisciplinary audience, this revision presents current data on antithrombotic therapy including warfarins and heparin, delivers practical techniques for diagnosing and treating bleeding and clotting disorders, and includes all topics[books.google.com]
  • Since that time, there has been no evidence presented to suggest that that conclusion is not accurate.[hematology.org]
  • Provide a differential diagnosis of neonatal thrombocytopenia and describe the clinical presentation and management of the most common forms.[pedsinreview.aappublications.org]
  • ITP is called acute when it has been present for less than one year and chronic when present for longer. The clinical onset may be rapid or gradual.[rarediseases.org]
  • In adults, ITP tends to be chronic, presenting with a more indolent course than in childhood, and unlike childhood ITP, infrequently following a viral infection.[mdedge.com]
Easy Bruising
  • bruising Platelet numbers between 30,000/μL and 80,000/μL Periods of remission and exacerbation range from near normal to fewer than 20,000/μL platelets appear normal, although larger in diameter than usual increased mean platelet volume megakaryocytic[quizlet.com]
  • A hereditary cause is suspected if there is a lifelong history of easy bruising; bleeding after tooth extractions, surgery, childbirth, or circumcision; or heavy menstruation.[merckmanuals.com]
Splenectomy
  • ., intravenous immunoglobulin G, anti-D, corticosteroids, and splenectomy. The cause of platelet destruction in most ITP patients appears to be autoantibody-mediated.[ncbi.nlm.nih.gov]
  • As for therapy, clearly corticosteroids and splenectomy are the mainstays.[hopkinsarthritis.org]
  • These include patients who have undergone splenectomy; several studies, including a large study that identified patients with ITP undergoing splenectomy through administrative codes, 3 suggest that thrombotic risk is increased more than 5-fold in the[hematology.org]
  • Splenectomy may be necessary to correct thrombocytopenia caused by platelet destruction. A splenectomy should significantly reduce platelet destruction because the spleen acts as the primary site of platelet removal and antibody production.[healthcentral.com]
  • Splenectomy improves platelet counts in approximately 70 percent of cases and can achieve a remission in 50 to 60 percent. Response rates are less in patients over 60 years of age.[rarediseases.org]
Falling
  • -Similar to hemolytic disease of newborn petechiae and purpuric hemorrhages, plts Infants recover in most cases 1-2 wks when antibodies clear up and platelet levels increase -Affected newborns have normal to decreased platelet numbers at birth Falling[quizlet.com]
  • Reviewer information: Stephanie Clarke, MS, MT (ASCP) has been teaching Medical Laboratory Science at the University of New Hampshire since fall 2014 and has served as the Assistant Program Director since fall 2015.[medialabinc.net]
  • And some of these diseases are due to a combination of factors causing them to fall into several low-platelet disease categories..[pdsa.org]
  • In some patients, occupational or physical therapy may be restricted due to the increased risk of bleeding and falls.[americannursetoday.com]
  • The normal production rate of the bone marrow cannot make up for the loss, which is why a fall in the number of platelets develop. This abnormal condition can be divided into immune and non-immune forms.[thrombocyte.com]
Ecchymosis
  • ITP symptoms may include: Small red dots on the skin caused by broken blood vessels (petechiae) Purple spots on the skin (purpura) Brusing on the arms and legs resulting from seemingly minor bumps (ecchymosis) Frequent or heavy nosebleeds (epistaxis)[nplate.com]
  • […] petechiae on the anterior chest, arms, neck, or oral mucous membranes spontaneous bleeding from the gums or both nostrils oozing of blood from incisions and intravascular catheter sites excessive vaginal bleeding occult blood in the stool hematuria ecchymosis[americannursetoday.com]
  • If you see someone with this ugly-looking bleeding in gums, and ecchymosis, you really need to get moving on a treatment because this could be a warning of potential intercranial hemorrhage, which we always worry about.[hopkinsarthritis.org]
Thrombosis
  • This practical text covers disorders of thrombosis and hemostasis in a logical and sequential manner: etiology, pathophysiology, clinical and laboratory diagnosis, and management.[books.google.com]
  • Surprisingly, recent studies have also demonstrated that patients with ITP have an increased risk of thrombosis. The data concerning ITP and thrombosis are derived from several sources.[hematology.org]
  • If the disorder happens at the level of the bone marrow, it may lead to extremely large number of platelets, increasing the risk of developing thrombosis, which can be life threatening.[thrombocyte.com]
  • In: Marder VJ, Aird WC, Bennett JS, et al, editors: Hemostasis and thrombosis: Basic principles and clinical practice, ed 6. Philadelphia, 2012, Lippincott Williams & Wilkins, in press.) Hematology Diagnosis and Treatment[clinicalgate.com]
Hepatosplenomegaly
  • Abstract Platelet volume distribution was examined in 16 patients with hepatosplenomegaly and platelet counts of 45 000 to 90 000/mm 3 ; 12 patients with autoimmune thrombocytopenia and randomly matched platelet counts; and 20 normal subjects.[annals.org]
Purpura
  • Patients with autoimmune thrombocytopenic purpura had values significantly greater than normal by 124% to 149% (mean, 134%) ( P 0.001).[annals.org]
  • Disorders that are associated with immune mechanisms of destruction include: Idiopathic (or immune) thrombocytopenic purpura (ITP) Heparin-induced thrombocytopenia (HIT) Neonatal alloimmune thrombocytopenia (NAIT) Increased destruction of platelets is[labce.com]
  • 2 general causes of platelet destruction Increase platelet destruction due to immunologic responses Increase destruction caused by mechanical damage or consumption Immune (idiopathic) Throbocytopenic purpura primarily a disorder in children (2-5 years[quizlet.com]
  • MDS) *TTP/HUS Thrombotic thrombocytopenic purpura/Hemolytic Uremic Symptom Table 5.[antimicrobe.org]
Petechiae
  • […] platelet destruction due to immunologic responses Increase destruction caused by mechanical damage or consumption Immune (idiopathic) Throbocytopenic purpura primarily a disorder in children (2-5 years old) occasionally in adults abrupt onset of bruising, petechiae[quizlet.com]
  • Painless, round and pinpoints (1 to 3 mm in diameter), petechiae usually appear and fade, and sometimes group to form ecchymoses.[healthcentral.com]
  • Findings on his physical examination are normal except for scattered crops of petechiae and multiple bruises. There is no active bleeding from the nose or other sites.[pedsinreview.aappublications.org]
  • Bleeding may range from small petechiae to large ecchymotic areas. Von Willebrand's disease is the most common hereditary coagulation disorder. It occurs in about 1% of the general population.[rnceus.com]
  • […] suspected in patients with petechiae and mucosal bleeding.[merckmanuals.com]
Retinal Hemorrhage
  • hemorrhage 25-50% cases are at risk for intracranial hemorrhage (plt count less than 4000) thrombocytopenia persists 6 months highest incidence of chronic ITP mucocutaneous bleeding Recurrent epistaxis Easy bruising Platelet numbers between 30,000/μL[quizlet.com]
Epistaxis
  • […] severe generalized purpura, GI bleeding, hematuria, retinal hemorrhage 25-50% cases are at risk for intracranial hemorrhage (plt count less than 4000) thrombocytopenia persists 6 months highest incidence of chronic ITP mucocutaneous bleeding Recurrent epistaxis[quizlet.com]
  • The general rule for abnormal bleeding not associated with trauma is: Bleeding into the skin and mucous membranes: ecchymoses, epistaxis, petechiae, gastrointestinal or genitourinary bleeding are suggestive of platelet disorders.[rnceus.com]
  • Clinical features associated with ITP are related to thrombocytopenia: petechiae (pinpoint microvascular hemorrhages that do not blanch with pressure), purpura (appearing like large bruises), epistaxis (nosebleeds), menorrhagia, gum bleeding, and other[mdedge.com]
  • ITP most often presents as petechiae, purpura, bleeding gums, epistaxis, and menorrhagia. Rarely, patients with acute ITP develop GI bleeding and hematuria.[americannursetoday.com]
  • ITP symptoms may include: Small red dots on the skin caused by broken blood vessels (petechiae) Purple spots on the skin (purpura) Brusing on the arms and legs resulting from seemingly minor bumps (ecchymosis) Frequent or heavy nosebleeds (epistaxis)[nplate.com]
Suggestibility
  • Early studies suggested ITP was primarily due to immune-mediated peripheral platelet destruction.[ncbi.nlm.nih.gov]
  • Subgroup analysis suggested a strikingly increased risk of myocardial infarction in the ITP cohort. Also suggested was a direct relationship between the severity of thrombocytopenia and the risk of thrombosis.[hematology.org]
  • These abnormalities may suggest bone marrow problems as the potential cause of thrombocytopenia. Abnormally shaped or ruptured red cells (schistocytes) seen on the blood smear may suggest evidence of HELLP, TTP, or HUS (see above).[medicinenet.com]
  • Bleeding into the joints or the retroperitoneum suggest coagulation factor abnormalities or warfarin toxicity. Bleeding into both joints and mucocutaneous tissue can suggest disseminated intravascular coagulation (DIC).[rnceus.com]
Intracranial Hemorrhage
  • hemorrhage (plt count less than 4000) thrombocytopenia persists 6 months highest incidence of chronic ITP mucocutaneous bleeding Recurrent epistaxis Easy bruising Platelet numbers between 30,000/μL and 80,000/μL Periods of remission and exacerbation[quizlet.com]
  • hemorrhage ITP: idiopathic thrombocytopenic purpura IVIG: intravenous immune globulin MCV: mean corpuscular volume MPV: mean platelet volume NAIT: neonatal alloimmune thrombocytopenia PT: prothombin time PTT: partial thromboplastin time TTP: thrombotic[pedsinreview.aappublications.org]
  • In rare cases of ITP, a serious condition known as bleeding into the brain (intracranial hemorrhage) may occur. Fatigue (even in the absence of anemia), anxiety, and depression are common experiences for people with ITP.[rarediseases.org]
Hematuria
  • […] detected to the platelet surface glycoproteins GPIIb and GPIIIa, GP Ia/IIa and megakaryocyte antibodies Gp IIb/IIIa and GP Ib/IX become target of autoantibodies mild cases: scattered petechiae 3-4% cases are severe generalized purpura, GI bleeding, hematuria[quizlet.com]
  • Rarely, patients with acute ITP develop GI bleeding and hematuria. On assessment, they may have a spleen of normal size, no other identifiable causes of thrombocytopenia, and normal bone marrow with a low platelet count.[americannursetoday.com]
  • […] the skin (purpura) Brusing on the arms and legs resulting from seemingly minor bumps (ecchymosis) Frequent or heavy nosebleeds (epistaxis) Heavy bleeding during menstruation (menorrhagia) Bleeding from the gums (gingival bleeding) Blood in the urine (hematuria[nplate.com]
  • Common clinical presentations of thrombocytopenia Petichial hemorrhages Echymoses or bruising Wet purpura, bleeding from mucus membranes of the mouth Bleeding from nose, gums, hematuria, or heavy menstrual flow in females, etc. Table 6.[antimicrobe.org]

Workup

Decreased Platelet Count
  • platelet counts that may become life threatening.[labce.com]
  • Bone marrow disease, side effects from drugs such as antineoplastics, and some infectious diseases can result in a decreased platelet count. Idiopathic thrombocytopenic purpura (ITP) is a condition in which antibodies form against platelets.[rnceus.com]
Decreased Platelet Count
  • platelet counts that may become life threatening.[labce.com]
  • Bone marrow disease, side effects from drugs such as antineoplastics, and some infectious diseases can result in a decreased platelet count. Idiopathic thrombocytopenic purpura (ITP) is a condition in which antibodies form against platelets.[rnceus.com]

Treatment

  • […] production include: reduced platelet turnover in over 80% of ITP patients, morphological evidence of megakaryocyte damage, autoantibody-induced suppression of in vitro megakaryocytopoiesis, and increased platelet counts in most ITP patients following treatment[ncbi.nlm.nih.gov]
  • […] platelet membranes --multiparous middle aged women --Antibody is directed to HPA-1a antigen or P1A2 or epitopes GPIIb/IIIa in 90% of cases --Need to have been previously exposed to foreign platelet antigens plasmapheresis and exchange transfusion IVIG treatment[quizlet.com]
  • Coagulation in Cancer. ed. / David Green; Hau Kwaan. 2009. p. 279-293 (Cancer Treatment and Research; Vol. 148).[scholars.northwestern.edu]
  • Standard Therapies Treatment While there is no well-established cure for ITP, almost all patients find their platelet count improves following treatment.[rarediseases.org]
  • A rapid response to these therapies supports the diagnosis of ITP; failure to respond to treatment should lead to further investigation of alternate causes of a low platelet count.[pdsa.org]

Prognosis

  • Differential diagnosis is important between ITP and other thrombocytopenic disorders, because the treatment and prognosis are distinct.[ncbi.nlm.nih.gov]
  • What is the prognosis for a person with thrombocytopenia (low platelet count)? The prognosis for someone with thrombocytopenia depends on the cause and the severity of the disease.[rxlist.com]
  • Describe the usual presentation and laboratory tests in the child who has acute idiopathic thrombocytopenic purpura, review the treatments, and know the usual prognosis.[pedsinreview.aappublications.org]
  • Prognosis The prognosis is very variable and will depend on the underlying condition.[patient.info]
  • Prognosis Thrombocytopenia can result in fatal bleeding, but it also can indicate various other, more serious, cancers and disorders that affect the blood cells. This condition requires thorough medical evaluation.[medical-dictionary.thefreedictionary.com]

Etiology

  • This practical text covers disorders of thrombosis and hemostasis in a logical and sequential manner: etiology, pathophysiology, clinical and laboratory diagnosis, and management.[books.google.com]
  • Since the etiology of thrombocytopenia in cancer patients may be multifactorial, diagnosis is often complex. The main causes of thrombocytopenia are increased platelet destruction and decreased platelet production.[scholars.northwestern.edu]
  • Etiology of thrombocytopenia in HIV patients. Primary HIV associated thrombocytopenia Hypersplenism Opportunistic infections Malignancy (Lymphoma, etc.) Medications TTP/HUS* Bone marrow problems (e.g.[antimicrobe.org]
  • The best proof of a drug-induced etiology is a prompt rise in the platelet count when the suspected drug is discontinued. Most people recover within seven to 10 days and do not require therapy.[healthcentral.com]

Epidemiology

  • Chronic immune thrombocytopenia in children: epidemiology and clinical presentation. Hematol Oncol Clin North Am. 2009;23(6):1223-38. Fogarty PF. Chronic immune thrombocytopenia in adults: epidemiology and clinical presentation.[rarediseases.org]
  • Chronic immune thrombocytopenia in adults: epidemiology and clinical presentation. Hematol Oncol Clin North Am. 2009;23:1213-1221. Aledort LM, Hayward CP, Chen MG, et al.[hematology.org]
Sex distribution
Age distribution

Pathophysiology

  • This practical text covers disorders of thrombosis and hemostasis in a logical and sequential manner: etiology, pathophysiology, clinical and laboratory diagnosis, and management.[books.google.com]
  • […] develop thrombotic complications effects occur 7-10 days after initiation of heparin therapy -occurs in patients who had experienced heparin anticoagulation -at certain heparin dose and requires increasing amounts of heparin -seen before thrombocytopenia pathophysiology[quizlet.com]
  • Therefore, a review of the pathophysiology, differential diagnosis, and management of thrombocytopenia is in order.[pedsinreview.aappublications.org]
  • Platelet kinetic studies have been performed to determine the pathophysiologic mechanisms in various thrombocytopenic states, particularly in complicated clinical situations.[accessmedicine.mhmedical.com]
  • Pathophysiology and thrombokinetics in autoimmune thrombocytopenia. Blood Rev. 2002;16:7-8. National Heart Lung and Blood Institute Diseases and Conditions Index. Idiopathic thrombocytopenic purpura. Accessed December 14, 2010.[itpanswers.com]

Prevention

  • Evidence for increased platelet destruction is thrombocytopenia following ITP plasma infusions in normal subjects, in vitro platelet phagocytosis, and decreased platelet survivals in ITP patients that respond to therapies that prevent in vivo platelet[ncbi.nlm.nih.gov]
  • This prevents some of the platelet clumping which can obstruct the blood flow to the heart. Aspirin is an effective medicine to prevent these clots, but it does not totally paralyze the platelet.[ouhsc.edu]
  • The enlarged spleen traps platelets and prevent them from circulating in the bloodstream.[my.clevelandclinic.org]
  • Can thrombocytopenia (low platelet count) be prevented? Thrombocytopenia may be preventable only if its underlying cause is known and preventable. For example, in patients with alcohol-induced thrombocytopenia, alcohol avoidance is recommended.[emedicinehealth.com]
  • In some cases, a transfusion of platelets may be required to stop or prevent bleeding. The outcome depends on the disorder causing the low platelet counts. Severe bleeding (hemorrhage) is the main complication.[medlineplus.gov]

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