Morning Report

Morning Report: Thrombocytopenia

Resident Presenter: Dr. Jen Stuart

54 yo F sent in by PCP for abnormal blood counts.  States that she has been having easy bruising for the past week.  Denies recent illness, h/o similar symptoms in the past, family h/o bleeding disorders.  Does admit to taking chronic NSAIDS for her chronic back pain.  Labs show platelet count of 8K. Patient is otherwise stable. No active bleeding. No hematuria, gum bleeding, or blood in stool.

Learning Points:

  • ITP criteria for diagnosis: isolated bleeding without constitutional symptoms (bone pain, weight loss, night sweats); no HSM; no lymphadenopathy or stigmata of congenital conditions; isolated TCP (platelet count <100 x 109/L); anemia only if due to significant bleeding- otherwise normal red cell indices, WBC and differentia; platelets are normal to large in size.
  • Most pts with no bleeding or mild bleeding (defined here as skin manifestations only, such as petechiae
 and bruising) can be treated with observation alone regardless of platelet count.
  • First-line treatment includes observation, corticosteroids, IVIg, or anti-D immunoglobulin (anti-D).
  • For most adults, longer courses of corticosteroids are preferred over shorter courses of corticosteroids or IVIg.
  • Previous treatment with corticosteroids, IVIg, or anti-D has been unsuccessful, subsequent treatment may include splenectomy, rituximab, thrombopoietin receptor agonists, or more potent immunosuppression

EBM Article:

Neunert C,
Lim W, Crowther M, Cohen A, Solberg L, and Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190-4207

Presented by the American Society of Hematology, adapted from: The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. (See attached)

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