Sana's rash & bruising

28 YO woman, with non itchy & non painful rash on her shins + easy bruising for the last 3 weeks
1. History
  1. Ask if there is pain anywhere
  2. Recent bleeding ?
    1. Petechiae \ Purpura in any place of the body
    2. Gum bleeding
    3. epistaxis
    4. Menorrhagia
    5. History of infection
      1. resolved URI
  3. Medical History
    1. A
  4. Family History
    1. A
  5. Diet , Alcohol and smoking
    1. Healthy
  6. History of travelling
    1. A
  7. Examination
    1. Notice & classify
      1. Petechiae
      2. Purpura
      3. Ecchymosis
    2. Palpate liver & spleen for hepatomegaly \ splenomegaly
    3. Investigations
      1. CBC
        very low platelets count
      2. Peripheral Blood smear
        To asses the morphology of the platelets & other blood cells
        increased size
      3. PT
        Evaluates the clotting factors in the intrinsic pathway
        Normal
      4. PTT
        Evaluates the clotting factors of the extrinsic pathway
        Normal
      5. BM Aspiration and
        for confirmation of the diagnosis and excluding malignancies
        High megakaryocytes
      6. Bleeding Time
        Prolonged
      7. Platelet Function assay
        Done to investigate and clotting factor deficiency
      8. +
    4. History and Examination suggest those DD , investigations are needed to diagnose
      1. II V
      2. Bleeding Disorders
        Vessel Wall Abnormalities
        Vit C deficiency
        systemic amyloidosis
        vasculitides
        Abnormal Clotting Factors
        Congenital
        hemophilia (A/B)
        --
        Excluded by age
        Acquired
        liver disease
        DIC
        Abnormal platelets
        Defective Platelet Function
        Bernard-Soulier syndrome
        What are platelets
        How they are formed
        Their functions
        They initiate the coagulation process and for the platelet plug in case of injury to the blood vessel
        (primary coagulation )
        <=
        Responsible for the secondary coagulation
        a clot is formed and prolonged bleeding is prevented
        tissue repair happen
        Thrombopoiesis
        tiny cells , less than 1% of blood. concentration is 150,000-450,000 \ nL. No nucleus but they have a mitochondria
        Reduced Platelets count
        ITP (Idiopathic Thrombocytepenic Purpura)
        Immune destruction of the antibody coated platelets
        can be classified
        Acute
        In children after viral infection
        Chronic
        women between 20-40
        Spleen is site of anti-platelet antibody production & major site of destruction of the IgG coated platelets.
        +
        Management
        Immunological
        IVIG
        +
        Increased platelets counts confirmed the diagnosis
        very effective treament
        surgical
        Splenectomy
        Pharmacological
        Corticosteroids
        Reduce destruction
        Thrombopoietin receptor agonists
        Antiplasmin agents
        Megakaryocytes growth factors
        incease poduction
        Risk factors
        gender \ female
        SLE
        Drugs
        infections
        pregnancy
        Acute Immune Thrombocytopenia
        DRUG-Induced Thrombocytopenia
        Heparin
        --
        No history for drug use
        HIV Associated Thrombocytopenia
        Infection
        viral
        bacterial
        parasitic
        --
        No IV drugs \ travelling history
      3. Cancer
        --
        No weight loss , investigations were clear
      4. Allergic reaction
        --
        No chemical exposure , no allergy symp
    5. Examin the lymph nodes
      1. Normal
  9. Exposure to chemicals
    1. A

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Sana's rash & bruising

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	Created by Samah Kannas over 4 years ago