Term
–_____
•extravasated blood outside blood vessels
Does not blanch |
|
Definition
|
|
Term
–_________: Extravasation without inflammation |
|
Definition
|
|
Term
______
•< 3mm
•Thrombocytopenia |
|
Definition
|
|
Term
|
Definition
|
|
Term
–Palpable purpura represents: ----------- |
|
Definition
| vasculitis (inflammation) |
|
|
Term
Thrombocytopenic Purpura
•Definition: |
|
Definition
| –Purpuric macules less than 3mm |
|
|
Term
Thrombocytopenic Purpura
–Causes
•____ (most common cause in adults)
•_____ (most common cause in children)
•HIV
•Collagen vascular diseases
•Hematologic malignancy
•ITP (idiopathic thrombocytoenicpurpura - immune system destroys platelets tx)
•TTP (inherited condition) |
|
Definition
|
|
Term
Thrombocytopenic Purpura
•History
–___ & ____ history
–Accompanied by (3) |
|
Definition
Drug and infection
fever, hemolytic anemia, and neurologic symptoms |
|
|
Term
Thrombocytopenic Purpura
•Physical Examination
–Petechiae most pronounced in areas of ___
–Examine ___ & ____
|
|
Definition
dependency
conjunctiva and mucosa |
|
|
Term
Thrombocytopenic Purpura
•Differential Diagnosis
–_____– cayenne pepper appearance (red-orange)
- ______– can also present with petechiae or purpura – treat w/ compression hose
|
|
Definition
Schamburg’s Disease
Venous Stasis |
|
|
Term
Thrombocytopenic Purpura
•Laboratory and Biopsy
–CBC and platelets
•Bleeding with platelets < _____
•Bleeding with minor trauma < ____
–UA and guaiac
|
|
Definition
|
|
Term
Thrombocytopenic Purpura
•Therapy
–Discontinuation of drug
–___ & _____ in children
–____ in adults to increase platelet production
–Chronic I(idiopathic) TP (platelets < 10,000) – _____
•Prolongs platelet survival
–______ with plasma replacement for TTP
|
|
Definition
Prednisone and IVIG
Prednisone
splenectomy
Plasmapheresis |
|
|
Term
Thrombocytopenic Purpura
•Course and complications
–Drug induced – _________
–Viral induced – _________
–ITP may require _________
–____ patients may present with ITP
–___ – 75% mortality rate before plasmapheresis implemented |
|
Definition
GI bleeding
resolves without therapy
splenectomy
SLE
TTP |
|
|
Term
Thrombocytopenic Purpura
•Pathogenesis
–drugs– (7)
–____ – inhibition of bone marrow production
–___ – inhibition of thromboxane production
–____-induced, AIDS-associated, Chronic ITP – autoimmune mechanism
•IgG antiplatelet antibodies bind to platelet membrane glycoproteins
–___ – cause unknown |
|
Definition
quinidine, quinine, sulfonamides, heparin, digitoxin, phenytoin, and methyldopa
Chemotherapy
Aspirin
Virus
TTP |
|
|
Term
Actinic Purpura
•Definition
–Purpura resulting from _____ fragility
–Dermal atrophy from ____ most common cause
|
|
Definition
blood vessel
sun exposure |
|
|
Term
Actinic Purpura
•Physical examination
–Ecchymoses around ____ & ____
–Skin ____ common
|
|
Definition
|
|
Term
Actinic Purpura
•Differential diagnosis
–____ use
–_______
•Around eyelids
–______ syndrome
•Hyperextensibility
|
|
Definition
Corticosteroid
Amyloidosis
Ehlers-Danlos |
|
|
Term
Actinic Purpura
•Therapy
–_________
|
|
Definition
|
|
Term
Actinic Purpura
•Pathogenesis
–Loss of ___ in the dermis resulting in blood vessel fragility
|
|
Definition
|
|
Term
Disseminated Intravascular Coagulation
•Definition |
|
Definition
| –Uncontrolled clotting resulting in diffuse thrombus formation |
|
|
Term
Disseminated Intravascular Coagulation
•Incidence
–Uncommon, life-threatening disease
–Occurs in setting of bacterial sepsis, malignancy (____ and AML), massive trauma, amniotic fluid embolism, or post-infection (purpurafulminans)
–Localized in patients with ____ deficiency when given warfarin (Coumadin necrosis)
•Occurs one week after therapy initiated
|
|
Definition
|
|
Term
Disseminated Intravascular Coagulation
•History
–fever & ____
–Stiff ____ with meningococcemia
–Malignancy
|
|
Definition
|
|
Term
Disseminated Intravascular Coagulation
•Physical examination
–____, stellate ecchymoses with a possible necrotic center
–Most lesions are ____
|
|
Definition
|
|
Term
Disseminated Intravascular Coagulation
•Laboratory and Biopsy
–Thrombocytopenia, _____, hypofibrogenemia, fibrinogen and fibrin degradation products
–____ & _____ most useful
–DIC score – uses the above to calculate overt DIC (> __)
|
|
Definition
prolonged PT
Platelet count and fibrinogen levels
5 |
|
|
Term
Disseminated Intravascular Coagulation
•Therapy
–Treat the underlying condition
–Replace clotting factors
•____
•____ (for fibrinogen and factor VIII)
•___ (for factor V, Protein C and S)
•____for coumadin necrosis
|
|
Definition
Platelets
Cryoprecipitate
Plasma
Heparin
"Coumadin is discontinued, intravenous heparin is started, fresh frozen plasma is given, and subcutaneous vitamin K is administered as an initial response." |
|
|
Term
Disseminated Intravascular Coagulation
•Course and Complications
•___% mortality rate
|
|
Definition
|
|
Term
Disseminated Intravascular Coagulation
•Pathogenesis
–Widespread ____ formation
–Coagulation factors are consumed
–Clotting process produces fibrinogen and fibrin degradation products
•Act as ______
|
|
Definition
|
|
Term
Vasculitis
•Definition
–____ of blood vessels
–Most often affects ____ vessels
–_________
•Mediated by neutrophils
•Seen with sepsis, SLE, RA, cryoglobulinemia, drug reactions, lymphoma, and myeloma
–_______
•Infection, drug
•Arthritis, abdominal pain, fever
•GI and renal vasculitis |
|
Definition
Inflammation
small
Leukocytoclastic vasculitis
Henoch-Schönlein purpura |
|
|
Term
Vasculitis
•History
–Rule out ____ disease
–___ vasculitis
•Neisseria meningitidis and gonorrhoeae, Staphylococcus aureus, Streptococcus pneumoniae, viridans streptococci, and Pseudomonaaeruginosa
•Rocky mountain spotted fever
–Begins on wrists and ankles and then involves palms and soles
–Obtain drug history
•(6 drugs)
|
|
Definition
systemic
Septic
Aspirin, gold, phenothiazines, penicillin, sulfonamides, and thiazides |
|
|
Term
Vasculitis
•Physical Examination
–____ purpura
–___ may follow – dark gray color in center of the lesion
–___ lesions may be seen with gonococcemia |
|
Definition
Palpable
Necrosis
Pustular |
|
|
Term
Vasculitis
•Differential diagnosis
–____ – may be flat or elevated
–Large vessel vasculitis
• (4)
–Goes from small vessels to large vessels
•____
|
|
Definition
DIC
Wegener’s nose, lungs, kidneys or PAN
Ulcerations |
|
|
Term
Vasculitis
•Laboratory and Biopsy
–___ in and around the blood vessels
–_______ - destruction of neutrophilic leaving nuclear debris
–Endothelial cell swelling
–Fibrinoid necrosis of the vessel wall
–Henoch-Schönleinpurpura
•____ deposition
–Obtain blood cultures
–UA, guaiac, CBC with platelet count, ESR, creatinine, SPEP, ANA, RA, Hep panel, and CXR
|
|
Definition
Neutrophils
Leukocytoclasis
IgA |
|
|
Term
Vasculitis
•Therapy
–Treat underlying disease
–Do NOT wait for cultures if ___ suspected
–Discontinue any offending drug
–Prednisone, dapsone, and colchicine for ___ vasculitis
|
|
Definition
|
|
Term
Vasculitis
•Course and complications
–Henoch-Schönleinpurpura
•Usually ______
•Renal impairment in 30%
–___ is the most frequently involved internal organ
|
|
Definition
|
|
Term
Vasculitis
•Pathogenesis
–Though to be immune complex-mediated disease
•Type ___ immune complex reaction
–Exogenous – ___ or ___
–Endogenous – ___, ____
|
|
Definition
III
bacterial or drug
RA, SLE |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Disseminated Intravascular Coagulation |
|
|
Term
|
Definition
|
|
