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bleeding disorders - Coggle Diagram
bleeding disorders
investigations to diagnose bleeding and coagulation disorders
-Blood smear
-complete blood count (CBC)
-fibrinogen assay
-prothrombin time (PT)
-Activated partial thromboplastin time (APTT)
-thrombin time (TT)
-Platelet Function Tests (aggregation study)
-D-dimer
-coagulation time
and many other tests
thrombocytopenia could be caused by
clinical manifestations of ITP
Reflection of thrombocytopenia
Bleeding manifestations = decreased platelet count
Normal vs low platelet count
ITP is diagnosed when the platelet count drops below 100000 cells per microliter.
In a previously healthy child
Petechiae
Purpura
Bleeding
Physical examination is normal
Rare: splenomegaly, lymphadenopathy, pallor
Bleeding gums
Nose bleeds
Heavier menstrual flow
Gastrointestinal bleeding
which it differs from children to adults
side effects/ complications of treatment of ITP
Thrombopoietin receptor agonist
increase platelets count
side effects
blood clots
dizziness
headaches
nausea
vomiting
Corticosteroids
block the immune response of the body.
side effects
infections
weight gain
high blood sugar
sleep difficulties
fluid retention
Antibody therapy
Example: RITUXIMAB (an antibody)
side effects
low blood pressure
fever
rashes
sore throat
Splenectomy
effective about 65 to 70 percent of the time.
side effects
puts you at risk for certain bacterial infections.
in some cases surgery is needed
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:white_flower:
incidence of ITP
Recent studies showed that the incidence is approximately between 2.9-3.9 per 100 000 adult .
The prevalence is 9.5 per 100 000 .
According to Age and gender
peak in children between 1-4 years .
women in childbearing age has high risk .
more elderly men are reported .
which can be determined clinically
difference between child and adult ITP
in children
duration of symptoms: 2-6 weeks
acute and self limited
platelet count: less than 20,000 platelets/microliter blood
cannot reoccur
in adults
duration of symptoms: months to years
platelet count: 30,000 to 80,000 platelets/microliter blood
chronic
prevalence: more in females
can reoccur
can be treated by
management of ITP
surgery
medication
steroids
Nplate and Promacta
immunoglobulin
Romiplostim
Eltrombopag
which might lead to
role of surgical intervention (splenectomy)
when do we do the procedure
Ruptured spleen.
Enlarged spleen.
Blood disorder.
Cancer.
Infection.
Cyst or tumor.
Hematologic indications
to treat a disease in which blood cells are destroyed in the pulpa;
to prevent splenomegaly and hypersplenism;
to stage Hodgkin's disease;
to clarify unclear splenomegaly with non-distinctive hematologic features.
The first choice treatments are steroids or IgG and plasmapheresis . Splenectomy is usually performed only in cases in which corticosteroid therapy fails to achieve remission. A very important part of the operative procedure is the careful search for accessory spleens. Remaining accessory spleens or accidentally reimplanted splenic tissue may cause recurrent thrombocytopenia after splenectomy.
thrombocytopenia
Is a condition where the platelets count are decreased .
causes
Destruction of cells by immune system .
Bone marrow depression
Bone marrow infiltiration
Low production of platelets as a result of viral infections, aplastic anemia.
thrombocytopenia could be diagnosed clinically
platelets physiology and homeostasis
homeostasis steps
the clotting process
injury or damage
factors are activated
vessels contract
caused by some factors
stimulating of local pain receptors
release of serotonin by anchored platelets
blood vessel injury
direct injury to the smooth muscle cells
platelet plug
Exposed collagen due to the damaged vessel
Von Willebrand Factor attaches to the collagen
Protein in the plasma
Released by Megakaryocytes, Platelets & Endothelial cell
Platelets come and attach to the VWF on the collagen.
Platelets release Thromboxin A2 and ADP
More platelets are attracted to the site
Plug is formed.
fibrin clot
Fibrin is a strong insoluble protein.
Converted from fibrinogen to fibrin
By the help of Thrombin, which is converted from Prothrombin.
Forms a blood clot.
knowing the function will allow us to understand the coagulation process
coagulation cascade
has two initial pathways which lead to fibrin formation
contact activation pathway
intrinsic pathway
tissue factor pathway
extrinsic pathway
which allow us to understand the causes of the abnormalities
clinical presentation of thrombocytopenia
signs and symptoms of thrombocytopenia
Purpura and petechiae
Prolonged bleeding or excessive bleeding
Heavy bleeding into the brain or intestine
Bleeding gum or nose
Having blood in the stool or urine
Fatigue
Enlarged spleen
Jaundice
Unusually heavy menstruated flow
Headaches and other neurological symptoms
such abnormalities in bleeding is best diagnosed after a lab test