TAILIEUCHUNG - INTERNAL MEDICINE BOARDS - PART 6

Không có quản lý cụ thể của 2 erythrocytosis ° là cần thiết. Việc xử lý các vera đa hồng cầu được bao phủ trong một phần riêng biệt. giảm tiểu cầu | HEMATOLOGY TA B L E . Evaluation of Erythrocytosis Labs Imaging Arterial O2 saturation RBC mass Ferritin B12 folate creatinine LFTs uric acid Abdominal ultrasound or CT scan Serum erythropoietin JAK2 mutation Treatment No specific management of 2 erythrocytosis is necessary. The treatment of polycythemia vera is covered in a separate section. Thrombocytopenia Defined as a platelet count 150 X 109 L. Its causes are outlined in Table . Diagnosis Examine a peripheral smear. TA B L E . Causes of Thrombocytopenia Cause Examples T destruction Immune thrombocytopenia 1 Autoimmune ITP . 2 Lymphoid malignancies HIV SLE alloimmunization from prior platelet transfusions. Drug induced Gold abciximab ticlopidine quinine heparin. Post-transfusion purpura. Microangiopathies TTP HUS eclampsia. DIC sepsis. Severe hypertension. Mechanical Artificial heart valves. Hemangiomas. Central venous catheters. Hypersplenism ị production Essentially any cause of marrow suppression can produce thrombocytopenia in isolation. See the pancytopenia discussion below. Probably the most important is drug-induced thrombocytopenia. Other Dilutional From massive blood transfusions and fluid resuscitation. Pseudothrombocytopenia From platelet clumping. 358 Rule out platelet clumping. Ask for a count smear done in citrate as EDTA the anticoagulant most often employed in tubes used to collect a CBC can cause clumping of platelets not seen on smear. Look for evidence of microangiopathy . schistocytes marrow suppression megaloblastic changes dysplastic changes and immature platelets giant platelets suggesting T platelet turnover. Take a careful drug history. Acetaminophen H2 blockers sulfa drugs furosemide captopril digoxin and P-lactam antibiotics are all associated with thrombocytopenia. Never forget heparin-induced thrombocytopenia see the discussion of clotting disorders below . Consider bone marrow biopsy if other findings suggest marrow dysfunction. Platelet-associated antibody tests are

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