3 hemostatis, itp

7/21/2019 3 Hemostatis, ITP

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1

Sumadiono

Pediatric DepartmentFaculty of Medicine

Gadjah Mada UniversityYogyakarta


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Hemostasis

Haemostasis is a process

- that prevents excessive blood loss in the body

3 primary mechanisms to control bleeding:

- Vascular spasm

- Plateletplug

- Blood clotting.


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vascular

.. ..


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Platelets Megakaryocytes prodce platelets in

bone marro!

"elease into circlation


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Upon ECs

desquamation,

platelets adhere

to

subendothelium

Platelets aggregatewith each other

to form

platelet plugs


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2000-2001 Prof dr A.J.P. Veerman PediatricHemato-Oncology VU-UGM

6

he haemostatic system!

primary haemostasis and platelet plug formation

"dhesion

"ctivation

"ggregation

#hite clot


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$oagulation

cascade


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8

#he haemostatic system:

secondary haemostasis and clot $ormation

"ctivation of the

coagulation cascadeleads to generation of

throm%in and& in turn&

fi%rin


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'aemostasis mechanism

video.hemos.flv videohemos2.flv
http://video.hemos.flv/http://videohemos2.flv/http://videohemos2.flv/http://video.hemos.flv/


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Screening test

Platelet count

Rumple Leede Test

Bleeding time (BT) Plasma Prothrombin Time (PPT) / PT

Activated Partial Thromboplastin

Time (APTT) Thrombin Time (TT)


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Platelet Count Manually or using blood analyer

!oral" #$%&%%%'$%&%%% / uL

(ormal

platelet count

hrom%ocy

)topenia

hrom%o

)cytosis


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Tourniuet Test/

Rumpel Leede Test

*etermines capillary +ragility

Measures the"

' ,unction - !umber o+ platelet' .trength o+ capillary all


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1

#%&"'()&*# #*+#

By a blood pressure cu++

0rapped around the upper arm

Mean o+ .ystole and diastole

,or a $ minutes

Aera +ossa cubiti" Positive i+" Petechie 1/2 #% *+.flv
http://rl.flv/http://rl.flv/


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Bleeding Time

A sharp s3in puncture is made andbleeding time is noted

!ormal " #'4 minutes

Prolonged values"' 5ascular de+ects

' 6ualitative - uantitative plateletabnormalities


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Bleeding

time

Duke method

using an ear lo%enormal! ,)-mnts

vy methodForearm is incisedPressuring constantly(ormal ! ,)/ minutes

0.flv
http://bt.flv/http://bt.flv/


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endothelin

collagen

vW vW

!aborator" e#aminations

Bleeding $ime % &!


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$issue

actor

'ctivation of

Coagulation s"stemplasminogenplasmin

(B&()*!+(

colla en

vW vW

P$ 'P$$ $$

!aborator" e#aminations

-P, -dimer

fibrin

BT


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,oaglation #est

$lotting time!

,ascade coaglation overal

hrom%in est 12#hird part o$ ,ascade

Prothrom%in est 1P or P2

*xtrinsic third part o$ cascade "ctivated Prothrom%in est 1aP2

(ntrinsic third part o$ cascade


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1!


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/isorders o$ Hemostasis

3ascular disorders+crvy0 easy brising0

Platelet disorders- (#

$oagulation disorders

Hemo$ilia0 Vit 2 de$eciency

Mi4ed5$onsumption! D$ 1Disseminatedintravascular coagulation2


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Bleeding Mani$estation

/e$. o$ #hrombocyteVasclar etechie0 *pistaxis

+mall *chimosis

Mcosal Bleeding

/e$. o$ ,%45&64#(%' 7act.

8oint#isse bleeding

6arge *chimosis

9ond Bleeding


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#hrombocytopenia

rodction de$ect

6ekemia

%ther Bone marro! de$ect

+rvival disorder o$ #hrombocyte

(diopathic thrombocytopenia rpra

(#;

acte:

,hronic: ?=>


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Thrombocytopenia

Platelet count < 150,000/l

< 20,000/ l: spontaneous

bleeding

Pseudo thrombocytopenia:

Platelets clump,

artifcially low platelet number

counted by machine !


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ITP(Idiophatic Thrombocytopenia

Purpura

/estroy o$ #hrombocyte

Mani$est ations:

- #hrombocytopenia @ 1==.===mm3;

- rpra

- 'o other cases


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Incidence

+imptomatic: 3-


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athophysiology

- Autoantibody to glicoprotein in

trombocyte membrane

- antibody-coated platelets is

destroyed by macrophage in lien & RES

4cte:

- ,ross reaction to in$ection immne respons

,hronic:

/e$ect o$ immne responsspeci$icthrombocyte antibody


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(# 4kt

+ering: sel$ limiting

#anpa #erapi0 hany observasi

Bila erdarahan berat mkosa;:

BM sebel steroidsE

FF megakaryocytes0 lekemia -;

rednisone ? mgkgday0 G mgg

(v(g5 mahal;


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Mani$estation

Bleeding:

- petechie0 connctiva0 epistaxis

'o systemic mani$estation

64B:

4nemia

4ntibody anti thrombocyte

BM: Megakaryocyte

Diagnosis! 64clude other disease


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Management

Supportive!

- 4ctivity @@

- revent trama

- 4void drgs that spressed thrombocyte

prodction

- *dcation

789! cure in : ;month


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/rgs cases thrombocytopenia

/ecreased thrombocyte prodction chemotherapy0 thiaAide0 alcohol0 estrogen0

chloramphenikol0 radiation

/estrction o$ thrombocyte

sl$onamide0 Iinidine0 kinine0 carbamaAepin0

valproat acid0 heparin0 digoxin @@ 7nction o$ trombosit

aspirin0 dipiridamol


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6o! thrombocyte @1=.===mm3;

,hronic (#

(o %leeding! o%servation

0leeding!de4amethasonSplenektomi

Sitostatika1cyclophosphamid& vincristin2

hrom%ocyte ransfusion! survival

P hr.flv
http://itp%20thr.flv/http://itp%20thr.flv/


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3 hemostatis, itp

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