Week 3
Hematopoietic Function
Hematopoiesis
 Process of forming blood
 Plasma: liquid protein
 Leukocytes: white blood cells
 Erythrocytes: red blood cells
 Hemoglobin: oxygen-carrying component
 Hematocrit: amount of blood volume occupied by
erythrocytes
 Thrombocytes: platelets
Review of Structure and Function
 blood, bone marrow, lymphoid tissues, mononuclear
phagocytic system, and the immune system
 Components are located in several organs
 Bone marrow, blood vessels, Spleen, lymph nodes, and
thymus
 Hematopoiesis means blood formation (hemato= blood)
 https://www.youtube.com/watch?v=RsKZWqsUpw&feature=player_embedded
Review of Structure and Function
 Red blood cells (RBC) aka erythrocytes
 Responsible for oxygen transport
 the amount moved is dependent on the amount of
hemoglobin in the red blood cell
 live about 120 days, and are removed by the spleen
 https://www.youtube.com/watch?v=_ZV5140OykE&feature=player_em
bedded
Iron Metabolism
 Transferrin: Transport protein for iron (each can bind to two iron)
 Ferrokinetics-movement of iron in the metabolic cycle
 Plasma iron clearance
 Plasma iron turnover/transport rate
 Utilization of newly formed RBC’s (RCV)
 Uptake turnover of iron
 RBC iron turnover (EIT)
Review of Structure and Function
Platelets (thrombocytes)
Short-lived fragments of a bone marrow cell,
responsible for clotting when needed
Must be replaced continuously
http://youtu.be/_yQD0U3ZtCs
Review of Structure and Function
White blood cells (WBC)
 Many different types, they are responsible for
inflammatory reactions and fighting infections
 Commonly called Leukocytes to refer to all types
Review: WBC’s
Granulocytes: short lived, stay in the blood
 Neutrophils, Eosinophils, Basophils
Lymphocytes: originate in bone marrow,
 some go to Thymus to become T lymphocytes for cell-mediated immunity,
 others go to lymphoid tissue to become B Lymphocytes or eventually become
plasma
Monocytes: most widespread
Circulate in blood for anti-inflammatory
response
Basically become specialized in every
tissue/organ in the body
Macrophages, histiocytes, RE cells, Kupffer cells.
Symptoms, Signs, and Tests
 Most hematopoietic diseases will cause nonspecific
symptoms
Physical exam: lymphadenopathy, splenomegaly
or hepatomegaly
Laboratory exams:
Biopsy: used to diagnose hematopoietic cancers
and diseases
Hemostasis
 Stoppage of blood flow
 Normal when it seals a blood vessel to prevent blood
loss and hemorrhage
 Abnormal when it causes inappropriate clotting or
when clotting is insufficient to stop blood flow
Stages of Hemostasis
1. Vessel spasm
2. Formation of platelet plug
3. Blood coagulation
4. Clot retraction
5. Clot dissolution
Organ Failure
The result of bone-marrow failure is
anemia, leukopenia, and
thrombocytopenia
These have the potential to increase
the likelihood of infection and bleeding
Specific Diseases
 Anemia's with decreased RBC production
Anemia of chronic disease is the most common,
and most difficult to treat
Iron-deficiency anemia
Vitamin B12-deficiency anemia (pernicious
anemia)
Myelophthisic anemia
Specific Diseases
 Disorders of WBC
Usually secondary to another illness
Leukopenia: too few WBC’s
Lymphopenia: too few Lymphocytes
 Disorders of Platelets
Idiopathic Thrombocytopenic Purpura (ITP)
 Believed to be the result of antibodies to platelets, associated with bleeding
from small vessels
Specific Diseases
Hyperplastic/Neoplastic Disease
Leukemia—WBC cancers
Lymphomas—WBC cancers
Multiple myeloma—cancer of the plasma cells
Polycythemia—increased RBC production
Disorders of the WBCs
 Leukocytes: key players in the inflammatory response
and in fighting infections
 Normal range = 5,000 to 10,000 cells/mL3 blood
 Leukopenia: decreased levels
 Leukocytosis: increased levels
Neutrophils
 One type of leukocytes
 Usually the first to arrive at the site of infection
 Normal range is 2,000–7,500 cells/mL
Neutropenia
(1 of 2)
Neutrophils < 1500 cells/mL
Causes
Increased usage
Drug suppression
Radiation therapy
Congenital conditions
Bone marrow cancers
Spleen destruction
Vitamin deficiency
Neutropenia
(2 of 2)
 Manifestations
 Depends on severity and cause
 Infections and ulcerations, especially of the
respiratory tract, skin, vagina, and
gastrointestinal tract
 Signs and symptoms of infection (e.g., fever,
malaise, and chills)
 Diagnosis: neutrophil levels and bone
marrow biopsy
 Treatment: antibiotic therapy and
hematopoietic growth factors
Infectious Mononucleosis
(1 of 2)
 “Kissing disease”—oral transmission.
 Self-limiting.
 Most prevalent in adolescents and young adults.
 Caused by Epstein-Barr virus in the herpes family.
 EBV infects the B cells by killing the cell or being
incorporated into its genome.
 Those B cells incorporated with EBV produce heterophile
antibodies.
 Once the disease is eliminated, a few B cells remain
altered, giving the individual an asymptomatic infection
for life and the potential to occasionally spread the EBV
to others.
Infectious Mononucleosis
(2 of 2)
 Manifestations
 Insidious onset.
 Incubation = 4–8 weeks.
 Initially see anorexia, malaise, and chills.
 Manifestations intensify to include leukocytosis, fever, chills, sore throat,
and lymphopathy.
 Acute illness usually lasts 2–3 weeks; may not fully recover for 2–3 months.
 Treatment: symptomatic and supportive
Lymphomas
 Cancers affect lymphatic system
 Most common hematologic cancer in the US
 Two main types
 Hodgkin’s
 Non-Hodgkin’s
Lymphoma
 Applied to an entire spectrum of malignant diseases involving the
lymphocytes
 Malignant lymphocytes infiltrate the lymph nodes, spleen, thymus,
bone marrow
 Extranodal lymphomas: lymphomas that originate in areas outside
the lymph nodes (solid organs, brain, skin, eyes, etc)
 May go into the blood and present as Leukemia
 Symptoms: node enlargement, fatigue, malaise, weight loss, fever,
sweating, anemia, leukopenia,
 Dx requires a lymph node biopsy
Non-Hodgkin’s Lymphoma
 More common
 Poor prognosis
 Many different types
 Similar to Hodgkin’s manifestations, staging, and treatment
 Different in the spread and diagnosis
 Can originate in the T or B cells
 No Reed-Sternberg cells
Non-Hodgkin’s Lymphoma
 Follicular: slow growing and most common
 Tumor cells resemble normal mature lymphocytes
 Chronic and slow growing, non responsive to chemo
 Diffuse large B cell:
 Group of lymphomas that occurs in several forms, responds to chemo
 Do not resemble normal lymph nodes
 Infiltrate normal tissues and spread to organs
 Burkitts:
 Small B cells divide rapidly and often have apoptosis
 Extra-nodal masses more prominent than enlarged nodes
 Most often presents with an abdominal mass
 Responds well to chemo and can be cured.
Hodgkin’s Lymphoma
(1 of 4)
 Least common of the two
 Solid tumors with the presence of Reed-Sternberg
cells
 Typically originate in the lymph nodes of the upper
body
 Several subtypes
 Very curable with treatment
 Manifestations: painless enlarged nodes, weight loss,
fever, night sweats, pruritus, coughing, difficulty
breathing, chest pain, recurrent infections, and
splenomegaly
Hodgkin’s Lymphoma
(2 of 4)
 Staging
 Stage I: The lymphoma cells are in one lymph node
group or one part of a tissue or an organ.
 Stage II: The lymphoma cells are in at least two lymph
node groups on the same side of the diaphragm, or the
lymphoma cells are in one part of a tissue or an organ
and the lymph nodes near that organ.
Hodgkin’s Lymphoma
(3 of 4)
 Staging
 Stage III: The lymphoma cells are in lymph
nodes above and below the diaphragm.
Lymphoma cells may be found in one part of
a tissue or an organ near these lymph node
groups. Cells may also be found in the spleen.
 Stage IV: Lymphoma cells are found in several
parts of one or more organs or tissues, or the
lymphoma cells are in an organ and in distant
lymph nodes.
 Recurrent: The disease returns after treatment.
Hodgkin’s Lymphoma
(4 of 4)
 Diagnosis: physical examination, presence of ReedSternberg cells in a lymph node biopsy, complete
blood count, chest X-rays, computed tomography
scan, magnetic resonance imaging, positron emission
tomography scan, and bone marrow biopsy
 Treatment: chemotherapy, radiation, and surgery
Hodgkin's Lymphoma
 Proper Staging is the most important factor for tx and
prognosis
 Lymph biopsies of nodes in the liver, spleen, and bone
marrow
 Symptoms: lymph node enlargement, fever, fatigue,
etc.
 Stage 1: single region involved
 Stage 2: 2 or more regions on the same side of the
body
 Stage 3: both sides of the body with or without the
spleen being involved
 Stage 4: wide spread, 2 + extranodal tissues or nonlymphoid organs
Hodgkin’s Lymphoma
4 classical types: Reed-Sternberg cells are binucleated or
multinucleated
 Nodular sclerosis
 Mixed cellularity
 Lymphocyte predominance
 Lymphocyte depletion
Non-typical: lymph nodes contain cells with popcorn nuclei.
 Lymphocyte rich
Multiple Myeloma
 Malignant plasma cells overgrowth in bone marrow
 Plasma cells are descendants of B lymphocytes
 Plasma cells secrete immunoglobulin and can be
detected in serum
 Monoclonal gammopathy: spike in immunoglobulin due to
increased cells
 Symptoms: infections, fracture, lytic bone lesions,
renal failure, purpura, Raynaud's syndrome, anemia,
leukopenia, thrombocytopenia, Bence Jones Protein
(proteinuria), renal failure
 DX: X-rays show bone lesions, blood tests show
hypercalcemia, bone marrow biopsy
 Grim Prognosis: Most patients die within 3-4 years
from renal failure or infections, chemotherapy does
not work.
Polycythemia
 Also called erythocytosis: too many red blood cells
 Primary is called polycythemia Vera
 Uncontrolled production of red blood cells and
increased red blood cells mass
 Secondary can be caused by chronic hypoxia, living in
high altitudes, congenital heart disease, renal
carcinoma, and chronic lung disease
 Symptoms: HTN, flushing in the face, headaches, visual
and cognitive problems, splenomegaly, thrombi
 Can lead to leukemia, considered neoplastic disease
 What does it mean for us:
 RBC mass
 P-32 treatment
Leukemia
 ALL leukemia's have the following:
 Bone marrow is infiltrated with malignant cells (bone marrow biopsy)
 Peripheral blood contains an increased number of immature blood cells
 Detected in blood tests, may be an early indicator
 Neoplastic stem cells with chromosomal changes specific to each type
 This is how we can tell which type
 Important for dx, prognosis, and treatment
 Complications include anemia, recurrent infections, uncontrollable
bleeding
 Malignant cells replace normal cells and disrupt hematopoiesis
Leukemia
 Acute lymphoblastic leukemia (ALL): most common form in children
 Acute Myelogenous Leukemia (AML): most common type (40%)
 Chronic Lymphoblastic Leukemia (CLL): almost unknown under 40 yrs
old
 Chronic Myelogenous Leukemia (CMl): rare in children, only 15% are
this type
Leukemia: All
 Immature lymphoid cells (precursor to T and B lymphocytes)
 Peripheral blood contains malignant lymphoid cells
 30% of all leukemia's, and most common childhood cancer
 Symptoms: splenomegaly, enlarged lymph nodes, weakness,
recurrent infections, bleeding into the skin and major organs
 Chemo is preferred, 2/3 can be cured, otherwise, fatal within 3-6
months
Leukemia: AML
 Proliferation of myeloblasts
 Most common form in adults
 Patients will die within 6 months without treatment, chemo may
induce remission
 Patients may receive radiation therapy and chemotherapy
 Four main types
 AML with recurrent genetic abnormalities
 AML from multi-lineage dysplasia
 Therapy related AML
 AML not otherwise specified
 This is divided further into 8 subtypes M0-M7
Leukemia: CLL
 Mostly occurs in adults over 50
 Involves lymphoid cells, cells are indistinguishable from normal
cells
 Indication is elevated lymphocytes in blood
 Confirmed with bone marrow biopsy
 Does not respond to chemo, most patients die in 9 years
 Very similar to small cell lymphoma
 Can transform into more aggressive forms of leukemia or
lymphoma
Leukemia: CML
 Malignant stem cells, may differentiate into neutrophilic leukocytes
 Patients have a high WBC counts
 Slow onset with mild anemia and hyper metabolism, fatigue,
recurrent infections
 Pts may have splenomegaly and increased clotting
 3 phases:
 Chronic
 Accelerated
 Blast crisis
 Chemotherapy does not work, most die within 3-5 years
 Bone marrow transplant, chemotherapy and radiation therapy
 Tyrosine kinase inhibitors
Leukemia
(1 of 4)
 Second most common blood cancer
 Cancer of the leukocytes
 Leukemia cells abnormally proliferate, crowding normal blood cells
 Risk factors: exposure to chemical, viral, and radiation mutagens;
smoking; use of chemotherapies; certain disease conditions (e.g.,
Down syndrome); and immunodeficiency disorder
Leukemia
(2 of 4)
 Types
 Acute lymphoblastic leukemia
 Affects primarily children
 Responds well to therapy
 Good prognosis
 Acute myeloid leukemia
 Affects primarily adults
 Responds fairly well to treatment
 Prognosis somewhat worse than that of acute lymphoblastic leukemia
Leukemia
(3 of 4)
 Types
 Chronic lymphoid leukemia
 Affects primarily adults
 Responds poorly to therapy, yet most patients live many
years after diagnosis
 Chronic myeloid leukemia
 Affects primarily adults
 Responds poorly to chemotherapy, but the prognosis is
improved with allogeneic bone marrow transplant
Leukemia
(4 of 4)
 Manifestations: leukopenia, anemia,
thrombocytopenia, lymphadenopathy,
joint swelling, bone pain, weight loss,
anorexia, hepatomegaly, splenomegaly,
and central nervous system dysfunction
 Diagnosis: a history, physical
examination, peripheral blood smears,
complete blood count, and bone
marrow biopsy
 Treatment: chemotherapy and bone
marrow transplant
Multiple Myeloma
(1 of 2)
 Plasma cell cancer (third most common)
 Excessive numbers of abnormal plasma cells in the
bone marrow, crowding the blood-forming cells and
causing Bence Jones proteins to be excreted in the
urine
 Bone destruction leads to hypercalcemia and
pathologic fractures
 Often well advanced upon diagnosis
Multiple Myeloma
(2 of 2)
Manifestations
Insidious onset
Include: anemia, thrombocytopenia, leukopenia,
decreased bone density, bone pain,
hypercalcemia, and renal impairment
Diagnosis: serum and urine protein, calcium,
renal function tests, complete blood count,
biopsy, X-rays, computed tomography, and
magnetic resonance imaging
Treatment: chemotherapy and
complication management
Disorders of the RBCs
 Erythropoiesis
 Production of erythrocytes
 Regulated by erythropoietin
 Occurs in bone marrow
 Disorders typically result from a deficit or defect in the
erythrocytes.
Anemia
 Results from a decreased number of erythrocytes,
reduction of hemoglobin, or presence of abnormal
hemoglobin
 Decreases O2-carrying capacity, leading to tissue
hypoxia
 Several types with varying etiology
 General manifestations: weakness, fatigue, pallor,
syncope, dyspnea, and tachycardia
Blood-loss anemia
 Caused by acute or chronic blood loss
 Where it applies?
 GI bleed studies
Iron-Deficiency Anemia
(1 of 2)
 Very common
 Iron is necessary for hemoglobin production
 Causes: decreased iron consumption, decreased iron absorption, or
increased bleeding
 Additional manifestations: cyanosis to sclera, brittle nails, decreased
appetite, headache, irritability, stomatitis, pica, and delayed healing
Iron-Deficiency Anemia
(2 of 2)
 Diagnosis: complete blood count (low hemoglobin,
hematocrit, MCV, and MCHC), serum ferritin, serum
iron, and transferrin saturation
 Treatment: identify and treat cause, increase dietary
intake, and administer iron supplements
Pernicious Anemia
(1 of 2)
 Vitamin B12 deficiency usually caused by a lack of
intrinsic factor.
 Cause: autoimmune.
 Vitamin B12 is required for DNA synthesis.
 Leads to decreased maturation and cell division.
 May see myelin breakdown and neurological
complications.
Pernicious Anemia
(2 of 2)
 Manifestations: bleeding gums, diarrhea, impaired sense of smell, loss
of deep tendon reflexes, anorexia, personality or memory changes,
positive Babinski’s sign, stomatitis, paresthesia, and unsteady gait
 Diagnosis: serum B12 levels, Schilling’s test, complete blood count,
gastric analysis, and bone marrow biopsy
 Treatment: injectable B12
Aplastic Anemia
(1 of 2)
 Bone marrow depression of all blood cells
(pancytopenia).
 Causes: idiopathic, autoimmune, medications,
medical treatments, viruses, and genetic
abnormalities.
 Onset may be insidious, sudden, and severe.
Aplastic Anemia
(2 of 2)
 Manifestations:
 Anemia (e.g., weakness, pallor, dyspnea)
 Leukocytopenia (e.g., recurrent infections)
 Thrombocytopenia (e.g., bleeding)
 Diagnosis: complete blood count and bone
marrow biopsy
 Treatment: identify and manage underlying
cause, oxygen therapy, infection control,
infection treatment, bleeding precautions,
blood transfusions, and bone marrow
transplants
Hemolytic Anemia
 Excessive erythrocyte destruction
 Causes: idiopathic, autoimmune, genetics, infections,
blood transfusion reactions, and blood incompatibility
in the neonate
 Several types including sickle cell anemia,
thalassemia, and erythroblastosis fetalis
Sickle Cell Anemia
(1 of 6)
 Neither recessive nor dominant—codominant.
 Hemoglobin S causes erythrocytes to be
abnormally shaped.
 Abnormal erythrocytes carry less oxygen
and clog vessels, causing hypoxia and
tissue ischemia.
 More common in people of African and
Mediterranean descent.
 Also seen in people from South and Central
America, the Caribbean, and the Middle East
Sickle Cell Anemia
(2 of 6)
 Forms of sickle cell anemia
 Sickle cell trait.
 Heterozygous.
 Less than half of erythrocytes are sickled.
 Sickle cell disease
 Homozygous.
 Most severe.
 Almost all erythrocytes are sickled.
Sickle Cell Anemia
(3 of 6)
 Manifestations
 Typically appear around 4 months of age
 Sickle cell crisis
 Painful episodes that can last for hours to days
 Pain caused by tissue ischemia and necrosis
 Triggered by dehydration, stress, high altitudes, and fever
Sickle Cell Anemia
(4 of 6)
 Manifestations include abdominal pain, bone pain,
dyspnea, delayed growth and development, fatigue,
fever, jaundice, pallor, tachycardia, skin ulcers,
angina, excessive thirst, frequent urination, priapism,
and vision impairment
Sickle Cell Anemia
(5 of 6)
 Diagnosis: hemoglobin electrophoresis, complete
blood count, and bilirubin test
 Life expectancy improving with better management
Sickle Cell Anemia
(6 of 6)
 Treatment
 No cure, palliative
 Stem cell research showing promise
 Medications (e.g., Hydrea [hydroxyurea])
 Avoid sickling triggers
 Other strategies: oxygen therapy, hydration, pain
management, infection control, vaccinations, blood
transfusions, bone marrow transplants, genetic
counseling
Thalassemia
(1 of 2)
 Autosomal dominant inheritance
 Abnormal hemoglobin from a lack of one of
two proteins that make up hemoglobin (alpha
and beta globin)
 Most common in people of Mediterranean
descent
 Also seen in those of Asian, Indian, and African
descent
 Manifestations: abortion, delayed growth and
development, fatigue, dyspnea, heart failure,
hepatomegaly, splenomegaly, bone
deformities, jaundice
Thalassemia
(2 of 2)
 Severe cases can lead to death in childhood.
 Life expectancy can improve with effective
management.
 Diagnosis: complete blood count (low MCV, MCHC)
and iron levels.
 Treatment: blood transfusion, chelation therapy, and
splenectomy.
Polycythemia
(1 of 2)
Abnormally high erythrocytes
Rare
Considered a neoplastic disease
Increased blood volume and viscosity,
leading to tissue ischemia and necrosis
Complications: thrombosis, hypertension,
heart failure, hemorrhage, splenomegaly,
hepatomegaly, and acute myeloblastic
leukemia
Polycythemia
(2 of 2)
 Manifestations: cyanotic or plethoric skin, high blood
pressure, tachycardia, dyspnea, headaches, visual
abnormalities
 Diagnosis: complete blood counts, bone marrow
biopsy, and uric acid levels
 Treatment: chemotherapy, radiation, phlebotomy,
and managing clotting disorders
Disorders of Platelets
 Normal platelet levels range from 150,000 to 350,000
cells/mL3
 Include issues in quantity and quality of platelets
 Thrombocytosis: increased levels
 Thrombocytopenia: decreased levels
Hemophilia A
 X-linked recessive bleeding disorder
 Deficiency or abnormality of clotting factor VIII
 Varies in severity
 Manifestations: bleeding or indications of
bleeding (e.g., bruising, petechia, etc.)
 Diagnosis: clotting studies and serum factor VIII
levels
 Treatment: clotting factor transfusions,
recombinant clotting factors, desmopressin
(DDAVP), and bleed precautions
von Willebrand’s Disease
(1 of 5)
 Most common hereditary bleeding disorder
 Decreased platelet adhesion and aggregation
 Manifestations: bleeding or indications of bleeding
(e.g., bruising, petechia, etc.)
von Willebrand’s Disease
(2 of 5)
 Forms of von Willebrand’s disease
 Type 1
 Most common and mildest form
 Follows autosomal dominant
 Reduced von Willebrand’s factor levels
 Can cause significant bleeding with trauma or surgery
von Willebrand’s Disease
(3 of 5)
 Forms of von Willebrand’s disease
 Type 2
 Either autosomal dominant or recessive.
 Five subtypes.
 von Willebrand’s factor building blocks are smaller than usual
or break down easily.
von Willebrand’s Disease
(4 of 5)
 Forms of von Willebrand’s disease
 Type 3
 Follows autosomal recessive
 No measurable von Willebrand’s factor or factor VIII
 Causes severe bleeding problems
 Acquired type
 Occurs with Wilms’ tumor, congenital heart disease, systemic
lupus erythematosus, and hypothyroidism
von Willebrand’s Disease
(5 of 5)
 Diagnosis: bleeding studies and factor VIII levels
 Treatment
 Mild cases usually do not require treatment
 Cryoprecipitate infusions
 Administration of desmopressin (DDAVP)
 Bleeding precautions
 Measures to control bleeding
Disseminated Intravascular
Coagulation
(1 of 2)complication of many conditions
 Life-threatening
 Results from an inappropriate immune response
 Widespread coagulation followed by massive bleeding because of
the depletion of clotting factors
 Manifestations: tissue ischemia and abnormal bleeding
Disseminated Intravascular
Coagulation
(2 of 2)
 Complications: shock and multisystem organ failure
 Diagnosis: complete blood count and bleeding
studies
 Treatment: identify and treat underlying cause,
replace clotting components, and prevent activation
of clotting mechanisms
Idiopathic Thrombocytopenia
Purpura
(1 of 5)
Hypocoagulation
resulting from an
autoimmune destruction of platelets
Acute form
More common in children
Sudden onset
Self-limiting
Chronic form
More common in adults age 20–50
More common in women
Idiopathic Thrombocytopenia
Purpura
(2 of 5)
 Causes: idiopathic,
autoimmune diseases, immunizations with a live
vaccine, immunodeficiency disorders, and viral infections
 Manifestations: bleeding or indications of bleeding (e.g., bruising,
petechia, etc.)
Idiopathic Thrombocytopenia
Purpura
(3 of 5)
 Diagnosis: complete blood count (platelet levels <
20,000/mL) and bleeding studies
 Treatment
 Acute ITP: glucocorticoid steroids, immunoglobulins,
plasmapheresis, and platelet pheresis
 Chronic ITP: glucocorticoid steroids, immunoglobulins,
splenectomy, blood transfusions, and
immunosuppressant therapy
Thrombotic Thrombocytopenic
Purpura
(4 of 5)
Deficiency
of enzyme necessary for
cleaving von Willebrand’s factor, leading to
hypercoagulation.
Hypercoagulation depletes platelet levels.
Characterized by thromboses,
thrombocytopenia, and bleeding.
Causes: idiopathic causes, heredity, bone
marrow transplants, cancer, medications,
pregnancy, and HIV.
Thrombotic Thrombocytopenic
Purpura
(5 of 5)
 Manifestations:
purpura, changes in consciousness, confusion,
fatigue, fever, headache, tachycardia, pallor, dyspnea on exertion,
speech changes, weakness, and jaundice
 Diagnosis: complete blood counts, blood smears, and lactate
dehydrogenase levels
 Treatment: plasmapheresis, splenectomy, and glucocorticoid steroids