Sana's rash & bruising

Description

Mind Map on Sana's rash & bruising, created by Samah Kannas on 04/27/2020.
Samah Kannas
Mind Map by Samah Kannas, updated more than 1 year ago
Samah Kannas
Created by Samah Kannas about 4 years ago
2
0

Resource summary

Sana's rash & bruising
  1. 28 YO woman, with non itchy & non painful rash on her shins + easy bruising for the last 3 weeks
    1. History
      1. Ask if there is pain anywhere
        1. Recent bleeding ?
          1. Petechiae \ Purpura in any place of the body
            1. Gum bleeding
              1. epistaxis
                1. Menorrhagia
                  1. History of infection
                    1. resolved URI
                  2. Medical History
                    1. A
                    2. Family History
                      1. A
                      2. Diet , Alcohol and smoking
                        1. Healthy
                        2. History of travelling
                          1. A
                          2. Examination
                            1. Notice & classify
                              1. Petechiae
                                1. Purpura
                                  1. Ecchymosis
                                  2. Palpate liver & spleen for hepatomegaly \ splenomegaly
                                    1. Investigations
                                      1. CBC
                                        1. very low platelets count
                                        2. Peripheral Blood smear
                                          1. To asses the morphology of the platelets & other blood cells
                                            1. increased size
                                          2. PT
                                            1. Evaluates the clotting factors in the intrinsic pathway
                                              1. Normal
                                            2. PTT
                                              1. Evaluates the clotting factors of the extrinsic pathway
                                                1. Normal
                                              2. BM Aspiration and
                                                1. for confirmation of the diagnosis and excluding malignancies
                                                  1. High megakaryocytes
                                                2. Bleeding Time
                                                  1. Prolonged
                                                  2. Platelet Function assay
                                                    1. Done to investigate and clotting factor deficiency
                                                    2. +
                                                    3. History and Examination suggest those DD , investigations are needed to diagnose
                                                      1. II V
                                                        1. Bleeding Disorders
                                                          1. Vessel Wall Abnormalities
                                                            1. Vit C deficiency
                                                              1. systemic amyloidosis
                                                                1. vasculitides
                                                                2. Abnormal Clotting Factors
                                                                  1. Congenital
                                                                    1. hemophilia (A/B)
                                                                      1. --
                                                                        1. Excluded by age
                                                                    2. Acquired
                                                                      1. liver disease
                                                                        1. DIC
                                                                        2. Abnormal platelets
                                                                          1. Defective Platelet Function
                                                                            1. Bernard-Soulier syndrome
                                                                            2. What are platelets
                                                                              1. How they are formed
                                                                                1. Their functions
                                                                                  1. They initiate the coagulation process and for the platelet plug in case of injury to the blood vessel
                                                                                    1. (primary coagulation )
                                                                                        1. <=
                                                                                          1. Responsible for the secondary coagulation
                                                                                              1. a clot is formed and prolonged bleeding is prevented
                                                                                                1. tissue repair happen
                                                                                    2. Thrombopoiesis
                                                                                    3. tiny cells , less than 1% of blood. concentration is 150,000-450,000 \ nL. No nucleus but they have a mitochondria
                                                                                    4. Reduced Platelets count
                                                                                      1. ITP (Idiopathic Thrombocytepenic Purpura)
                                                                                        1. Immune destruction of the antibody coated platelets
                                                                                          1. can be classified
                                                                                            1. Acute
                                                                                              1. In children after viral infection
                                                                                              2. Chronic
                                                                                                1. women between 20-40
                                                                                              3. Spleen is site of anti-platelet antibody production & major site of destruction of the IgG coated platelets.
                                                                                                1. +
                                                                                                2. Management
                                                                                                  1. Immunological
                                                                                                    1. IVIG
                                                                                                      1. +
                                                                                                        1. Increased platelets counts confirmed the diagnosis
                                                                                                        2. very effective treament
                                                                                                      2. surgical
                                                                                                        1. Splenectomy
                                                                                                        2. Pharmacological
                                                                                                          1. Corticosteroids
                                                                                                            1. Reduce destruction
                                                                                                            2. Thrombopoietin receptor agonists
                                                                                                              1. Antiplasmin agents
                                                                                                                1. Megakaryocytes growth factors
                                                                                                                  1. incease poduction
                                                                                                              2. Risk factors
                                                                                                                1. gender \ female
                                                                                                                  1. SLE
                                                                                                                    1. Drugs
                                                                                                                      1. infections
                                                                                                                        1. pregnancy
                                                                                                                      2. Acute Immune Thrombocytopenia
                                                                                                                        1. DRUG-Induced Thrombocytopenia
                                                                                                                          1. Heparin
                                                                                                                            1. --
                                                                                                                              1. No history for drug use
                                                                                                                            2. HIV Associated Thrombocytopenia
                                                                                                                          2. Infection
                                                                                                                            1. viral
                                                                                                                              1. bacterial
                                                                                                                                1. parasitic
                                                                                                                                  1. --
                                                                                                                                    1. No IV drugs \ travelling history
                                                                                                                                2. Cancer
                                                                                                                                  1. --
                                                                                                                                    1. No weight loss , investigations were clear
                                                                                                                                  2. Allergic reaction
                                                                                                                                    1. --
                                                                                                                                      1. No chemical exposure , no allergy symp
                                                                                                                                  3. Examin the lymph nodes
                                                                                                                                    1. Normal
                                                                                                                                    1. Exposure to chemicals
                                                                                                                                      1. A
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