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Bleeding Diathesis (:three: Derangements of Coagulation Deficiencies…

- - - - Collagen Vascular Disease
        
        Rheumatoid Arthritis
        
        SLE
      - Drug Reactions
        
        Hypersensitivity /
        Leukocytoclastic Vasculitis
        (Neutrophils break down)
      - Unknown Antigen
        
        Henoch-Schonlein Purpura :star2:
        IgA immune compleses deposit in vessels
        Onset after URI
        
        Purpuric rash
        
        Colicky abdominal pain (pseudo appendicitis)
        
        Polyarthralgia
        
        Acute glomerulonephritis
  - - - AL Amyloid
        
        Deposits around skin of :eye:
        (Multiple Myeloma)
      - Cerebral Amyloid Angiopathy (CAA)
        
        A-Beta amyloid accululation
        
        Familial
        
        W or W/O Alzheimer's
        
        :!!: 2nd most common non-traumatic cerebral hemorrhage
- - - - Immune thrombocytopenia Ab
        
        Autoantibodies
        
        AUTOANTIBODIES causing Thrombocytopenia
        FILL IN DETAILS FOR THIS SECTION LATER
        
        SECONDARY:
        
        Drug Associated
        
        Quinidine
        
        Sulfonamides
        
        Heparin
        
        Infections
        
        HIV :star2:
        
        CMV
        
        EBV
        (infectious mono)
        
        Autoimmune Collagen Vascular Disease
        
        SLE
        
        Chronic Lymphocytic Leukemia
        
        Platelet Inhibitory Drugs
        
        Clopedigrel
        
        PRIMARY:
        Idiopathic Immune Thrombocytopenic Purpura
        (ITP)
        
        IgG autoantibodies target epitopes on platelet glycoproteins (Ib & IIb/IIIa)
        :arrow_down:
        
        IgG binds platelet antigens
        :arrow_down:
        
        Platelets opsonized (in spleen)
        
        :warning:DO NOT GIVE PLATELET TRANSFUSION
        
        Acute
        < 3 mon, persists 3-12 mo
        
        Childhood, M=F
        
        SEASONAL, 2 wks after viral illness
        
        Abrupt onset bruising
        
        80% self-limited
        
        :pill: Rx for severe: IVIG, corticosteroids
        
        Chronic
        > 12 month
        
        Adult (<40) :female_sign: > :male_sign: (3:1)
        
        Insidious onset bleeding into skin mucosa
        
        Relapse common
        
        :pill: Rx:
        
        Immunosuppress/immunomodulation, corticosteroids, IVIG, Anti-CD 20
        
        Thrombopoietin receptor agonists
        
        Splenectomy (last line)
        
        Morphology:
        
        Petechiae, purpura
        
        Spleen NORMAL (congested sinusoids, enlarged follicles of B cells)
        
        :arrow_up: Megacaryocytes in bone marrow (immature)
        
        :arrow_up: Thrombocytopenia (large platelets - MPV :arrow_up:)
        
        Alloantibodies
        
        Past transfusion OR
        
        Pregnancy
        
        Neonatal Thrombocytopenia:
        
        Maternal Ab x placenta to fetus
        
        Immune-mediated platelet destruction
        
        1st pregnancy
        
        Each pregnancy can get worse!
    - - Hypersplenism Triad:
        
        Splenomegaly
        
        Thrombocytopenia
        
        Increased platelet production by bone marrow
    - - TTP
      - HUS