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BLEEDING DISORDERS, THROMBOCYTOPENIA, IMMUNE THROMBOCYTOPENIC PURPURA…

- - - - Hereditary Haemorrhagic telangiectasia
        
        Inherited disorders of connective tissue matrix
        (Marfan’s Syndrome, Ehlers-Danlos Syndrome)
    - - Henoch-Shonlein purpura
        
        Haemolytic-uraemic syndrome
        
        Devil’s pinches Infection
        
        Drug reactions
        
        Steroid purpura
        
        Senile purpura
        
        Scurvy
  - - - Due to reduction in
        No.of Platelets
        
        Thrombocytopenias
      - Due to rise
        in platelet count
        
        Thrombocytosis
      - Defective
        platelet function
        
        Hereditary
        
        Acquired
- - - - Immune mechanism by formation of drug-antibody complexes
        
        Clinical features
        
        acute purpura
        
        Lab findings
        
        platelet count below 10,000/microliters, bone
        marrow shows normal or increased number of megakaryocytes
        
        Treatment
        
        stop or replace suspected drug, occasionally may
        require temporary glucocorticoids, plasmapheresis or platelet
        transfusion
    - - THROMBOCYTOPENIA
        CHEMOTHERAPEUTICAGENTS
        
        ALKYLATING AGENTS
        
        ANTHRACYCLINES
        
        ANTIMETABOLITES
        
        ANTIOBIOTICS
        
        SULFONAMIDES
        
        PAS
        
        RIFAMPICIN
        
        PENICILLINS
        
        CV DISEASES
        
        DIGITOXIN
        
        THIAZIDE DIURETICS
        
        OTHER
        
        DICLOFENAC
        
        ACYCLOVIR
        
        HEPARIN
        
        EXCESSIVE CONSUMPTION OF
        
        ETHANOL
- - - - Splenic
        sequestration
- - - - Pathogenesis
        
        formation of anti-platelet autoantibodies, usually by
        platelet-associated IgG humoral antibodies synthesized by spleen.
- - - - Blood film : occasional platelet, often large in size
        
        Bone marrow : increased no.of
        megakaryocytes, large lobulated single nuclei
        
        Anti-platelet IgG antibody
        
        Platelet survival studies : reduced platelet
        lifespan
    - - Spontaneous recovery in
        90% cases of acute ITP,
        10% in chronic ITP
        
        Reduce level and source of autoantibody,
        
        reduce rate of destruction of sensitized platelets
        
        Corticosteroid therapy,
        
        immunosuppressive drugs
        (vincristine, cyclophosphamide, azathioprine)
        
        Splenectomy : removal of major site of platelet destruction and
        major source of autoantibody synthesis
        
        Platelet transfusions are palliative for severe haemorrhages
- - - - occurs after 5 – 10 days of heparin
      - 4 T’s
        
        Thrombocytopenia,
        
        Thrombosis,
        
        Time of fall of platelets,
        
        absence of other causes of
        Thrombocytopenia