Learning Objectives1. Distinguish between physiologic and pathologic thrombocytopenia
<30k=spontaneous bleed<60-70k = bleed from sx or traumatic injuryKCS (King Charles Spaniel) = physiologic breed related - below ref range but not in danger zone
2. Formulate a diagnostic plan for the thrombocytopenic patient and recognize how to diagnoseIMTP
Do fundic exam to check for retinal hemorrhage do not:Do not phlebotomize jugularcollect arterial samplescatheterize urethra or perform cystoperform BMBTminimize venipuncture or avoid catheters CBC- platelet - reticulocyte count Coomb's Test: r/oIMHAClotting testInfectious disease test: FeLV, FIV, Fungal, RickettsialPlatelet count ITP: less than 30k, usually less than 10kDIC: More than 50kAdvanced: 1) BM biopsy2) Platelet flow cytometry3) BM Immunofluorescence
3. Construct a treatment plan for a patient with IMTP
Re-establish platelet count (by restoring immune system) Control bleeding Eliminate (or control) underlying disease Whole blood transfusions - use fresh from donor- will not correct platelet count due to recipient antibody Crystalloid therapy as appropriate (may require shock bolus) Platelet products 1) Platelet rich plasma - often impractical- expensive- platelet function may be abnormal 2) Platelet concentrates (DMSO cryopreserved)GlucocorticoidsEnteric protection (use omeprazole and sucralfate)Secondary immunomodulatory drug (not clear evidence for it) clinically: can use to reduce steroids ex: Vincristine bolusSurgical: Splenectomy (check BM before take out spleen in case spleen is doing all work for BM)
4. Describe the general prognosis for a patient with IMTP
Good, better than IMHALow relapse rate