Sana with Rach and Easy bruising

Thrombopoiesis
1. Process by which mature platelets are generated within the bone marrow.
2. Function
  1. -Hemostasis -Membrane receptors -Actin, myosin & thrombosthenin -Fibrin-stabilizing factor -Growth factors
  2. Hemostasis means prevention of blood loss.
    1. 1-vasoconstriction
    2. 2-formation of blood clot
    3. 3-Blood coagulation to form a blood clot
      1. mechanism
bleeding disorder
1. investigations
2. causes
  1. thrombocytopenia: below Below 20,000 cells/ul
    1. caused by:
      1. 2-Decreased production: Aplastic aneamia- megaloblastic anemia-drugs- infectionHIV- leukemia
      2. 1-Decreased survival: immune thrombocytopenic purpura (ITP)-drug induced (heparin- quinidine)-Dissiminated intravascular coagulopathy (DIC)- thrombotic thrombocytopenic purpura (TTP)
  2. DIC:Systemic activation of coagulation factors – formation of microthrombi throughout the circulation-consumptive coagulopathy.
    1. secondary to many condition: -Obstetric: MAJOR OB complications; toxemia, sepsis, abruptio placenta, retained dead fetus -Infections: Gm-, meningococcemia, fungi, Malaria -Many neoplasms; AML, adenocarcinoma -Massive tissue injury; trauma, burns, surgery
  3. Heparin induced thrombocytopenia
    1. IgG bind to platelet factor 4 on platelet membrane in a heparin dependent fashion leading to platelet activation platelet aggregation resulting in thrombosis.
  4. Vascular Bleeding Disorders
    1. 1-Congenital defects of the vessel wall: Ehlers- Danlos syndrome
    2. 2-Senile purpura: defect in the subcutaneous tissue supporting the bvs
    3. 3-Scurvy vitamin: C deficiency
    4. 4-Septic Vasculitis Infections :(meningococcaemia, infective endocarditis, measles, rickettsia)
  5. plasma abnormalities
3. types
Idiopathic thrombocytopenic purpura (ITP)
1. disorder that can lead to easy or excessive bruising and bleeding. The bleeding results from unusually low levels of platelets
2. types
3. pathophysiology
  1. An autoantibody usually an IgG will be formed in the spleen and that antibody will be directed against certain glycoproteins on the platelet surface (llb/lib, lb/IX) . After the binding of the antibody to the platelet surface, circulatng antibody-coated platelet are recognised by the Fc receptor on splenic macrophages, it will be ingested and destroyed.
4. common risk factors
  1. -Genetics:Having close relatives who have also been diagnosed with ITP can sometimes increase the risk -Gender -Age -Receiving certain vaccines. Although very rare, some vaccinations can “trigger” ITP. -Viral infections. Sometimes, after a bout with the mumps, measles or other viruses, children can get ITP.
5. signs & symptoms
  1. either internal or external bleedin
    1. bleeding include: Petechiae (< 3mm) Purpura (3-10 mm) Ecchymoses (> 1 cm) Hematoma Nosebleeds or bleeding from the gums Blood in urine or stool Any kind of bleeding that's hard to stop could be a sign of ITP  Menstrual bleeding that's heavier than normal
6. Diagnosis
  1. CBC: low platelet count
  2. bone marrow biopsy & inspiration: normal to increased megakaryocytes to compensate for the platelets loss
  3. PT& PTT for coagulation cascades: normal
  4. peripheral smear
7. Complications
  1. -Menorrhagia -Intracranial bleeding is rare -Petechial rash -Epistaxis -gum bleeding -Easy bruising
8. management
  1. -Stop using any drug that might inhibit platelet function- Drugs that suppress your immune system -Injections to increase your blood count:injection of immune globulin (IVIG) -Drugs that boost platelet production
9. treatment
  1. -Steroids + Steroid-sparing agents -IVIG or Anti Rh (D)- immunoglobulin -Rituximab -Platelets transfusion
    1. Treatments for Resistant Disease
      1. -Other drugs. Azathioprine (Imuran, Azasan) has been used to treat ITP.
      2. Removal of the spleen. (splenectomy)
        spleen
        function:- filter for blood as part of the immune system.- Old red blood cells are recycled in the spleen, and platelets and white blood cells are stored there. -helps fight certain kinds of bacteria that cause pneumonia
        recommended that people with asplenia are vaccinated against Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae. AKA SHiN.

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Sana with Rach and Easy bruising

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	Criado por Dana Alobadily mais de 7 anos atrás