Hemostasis

Hemostasis

1. Primary

   • Platelets
     • Abnormal function
     • Abnormal number
       • Sequestration
         • Splenomegaly
       • Increased destruction
         • Immune
           • ITP
             • Immune Thrombocytopenic Purpura (ITP)
             • Pathophysiology
               • Anti-platelet antibodies bind to platelets. Platelets get destroyed by spleen. 
               • Anti-platelet antibodies
             • Diagnosis
               • Diagnosis of exclusion
               • Diagnosis of exclusion
             • Presentation
               • - Asymptomatic - Minimal bruising to severe bleeding
               • Asymptomatic
               • Mild to severe bleeding
             • Investigations
               • - CBC and retics: thrombocytopenia - PT and PTT normal- Test for HIV and HCV (increased risk factors)- Blood smear: decreased platelets, giant platelets- Bone marrow biopsy: increased number of megakaryocytes
               • CBC and retics
                 • Thrombocytopenia
               • PT and PTT
                 • Normal
               • Bone marrow biopsy
                 • Increased number of megakaryocytes
               • Blood smear
                 • decreased and giant platelets
               • Test for HIV and HCV
             • Treatment
         • Non-immune
           • TTP
             • Pathophysiology
               • Can't breakdown vWF multimers
                 • Congenital (ADAMST13)
                 • Acquired
             • Presentation
               • Thrombocytopenia
                 • Purpura
                 • Hx of bleeding
                 • Bruising
               • MAHA
                 • (L) haptoglobin
                 • (H) indirect bili
                 • Retics
                 • (H) LDH
               • Renal failure
               • Fever
               • Neurologic symptoms
                 • Confusion
             • Investigations
               • CBC and blood smear
                 • Schistocytes
                 • (L) platelets
                 • Indirect bili
                 • (H) LDH
                 • (L) haptoglobin
               • PT amd PTT
                 • Normal
               • Coomb's test
                 • Negative (non-immune)
               • Renal fxn
                 • Creatinine
                 • Urea
             • Diagnosis
               • Thrombocytopenia
               • MAHA
             • Treatment
               • Plasmapheresis
                 • + steroids
               • Plasma transfusion
           • HIT
           • HUS
       • Decreased production
   • vWD
   • Vascular

2. Secondary