SANA with Rash and Easy Bruising

Platelets
1. 1 to 4 um in diameter
2. platelet count =150,000-300,000/mm3
3. Functions
  1. hemostasis
    1. prevention of blood loss
      1. when a blood vessel is injured
        1) vascular constriction
        2) Formation of platelet plug
        3) formation of blood clot
    2. involves
      1. endothelium
      2. platelet
      3. clotting factors
  2. formation of platelet plug
  3. release of vasoconstrictors
  4. wound repair-growth factor
  5. facilitates blood coagulation
4. Thrombopoiesis
  1. stimulated by
    1. Thrombopoietin
    2. MGDF
    3. Il-6
    4. GMCSF
5. life span= 8-12 days
  1. eliminated by spleen-macrophages
History Taking of Bleeding disorders
1. family history
  1. congenital or acquired?
2. alcohol
  1. acute
    1. TCP
    2. BM toxicity
  2. chronic
    1. liver cirrhosis
3. medication
  1. Aspirin and NSAIDS
  2. immunosuppressant
4. weight loss/ fever?
5. Blood Investigations
  1. CBC
    1. platelet count
      1. 150,000-450,000/mm3
    2. platelet morphology
      1. schistocytes?
  2. PT
    1. Extrinsic and common pathway
      1. 12-14 sec
  3. PTT
    1. intrinsic and common pathway
      1. 24-35 sec
  4. BT
    1. 2-7 mins
BLEEDING DISORDERS
1. vessel wall
  1. septic vasculitis
  2. henoch Schönlein syndrome
    1. immune complex vasculitis
  3. herlers danlos disorder
    1. congenital defect in BV
2. Platelets
  1. number
    1. thrombocytopenia
      1. decreased production
        aplastic/megaloblastic anemia
        leukemia
        myelosuppression:chemotherapy/alcohol
      2. increased destruction
        Immune thrombocytpenic purpura
        igG antibodies made by the spleen, attacking platelets at 1b and 11b receptors, causing the destruction of them within the spleen
        acute ITP
        children 2-9 years
        less than 6 months
        resolves after 6 months by itself
        follows a viral infection
        severe cases
        splenectomy
        chronic ITP
        adults;females 20-40 years
        6 months or longer
        secondary causes
        SLE
        HIV
        diagnosed by exclusion
        number of platelets increased by corticosteroids
        thrombotic thrombocytopenic purpura
        PENTAD
        fever
        thrombocytopenia
        Microangiopathic hemolytic anemia
        renal failure
        neuro deficits
        deficiency of enzyme that breaks down vWF
        Disseminated Intravascular Coagulopathy
        Consumptive coagulopathy
        systemic activation of clotting factor and platelets
        microthrombi formation
        increased bleeding tendency
        MEDICAL EMERGENCY
        Heparin induced thrombocytopenia
        igG binds to platelet factor 4, leading to platelet activation, platelet aggregation and thrombosis formation
  2. function
    1. congenital
      1. glannzman thrombasthenia
        abnormality in glycoprotein 11b/111a
      2. bernard soulier disease
        no binding between glycoprotein 1b with vWF
    2. acquired
      1. ASPIRIN
        prevents thromboxane formation by cox1
  3. superficial bleeding
    1. purpura
      1. pinpoint hemorrhages
    2. petechiae
      1. 3-5 mm hemorrhages
    3. ecchymosis
      1. large bruises
3. Clotting Factors
  1. inherited
    1. Hemophilia
      1. X linked recessive
        factor 8 deficiency
        Hemophilia A
        factor 9 deficiency
        Hemophilia B
        PTT elevated
    2. Von willebrand disease
      1. Autosomal dominant
        absence of vWF
        involved in
        prevention of degradation of factor 8
        platelet adhesion to damaged endothelium via 1b
        PTT and bleeding time elevated
  2. acquired
    1. vitamin K deficiency
      1. PT and PTT increased
    2. liver disease
      1. deficiency of all clotting factors
  3. clinical presentation
    1. hemearthrosis
      1. bleeding into joints
    2. hematoma
      1. bleeding into soft tissue

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SANA with Rash and Easy Bruising

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	Criado por Salma Mk quase 7 anos atrás