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A - 03 - Akut Itp
A - 03 - Akut Itp
5/9/17 3
SEPINTAS MENGENAI A
TROMBOSIT / PLATELET
TROMBOSITOPENIA
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A smear of human perypheral blood, from :www.uoguelph.ca/zoology/devobio/210labs/ct2.html
ETIOLOGY OF
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THROMBOCYTOPENIA
A). Destructive Thrombocytopenia:
Immunologic (Terbanyak)
ITP
Thrombotic thrombocytopenic purpura
Drug induced
Post-tranfusion purpura
Autoimmune disease
Post-transplant
Hyperthyroidism
Lymphoproliferative disorders
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4
B). Nonimmunologic
Microangiopathic disease
Hemolytic anemia and thrombocytopenia
Hemolytic-uremic syndrome
C). Platelet Consumption/Destruction
DIC
Giant Hemangiomas
Cardiac (prosthetic heart valves, repair of intra
cardiac defect)
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SUB POKOK BAHASAN
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IDIOPATHIC THROMBOCYTOPENIC
PURPURA ( ITP )
Acute ITP :
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SUB POKOK BAHASAN
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Chronic ITP :
- persistent thrombocytopenia > 6 months
- child < 1 year, or > 10 years of age
- may have an associated autoimmune
disease or immunodeficiency state
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ptechiae 8
purpura conjunctival
hemorrhage
HowellJolly
bodies = bulat
licin, sisa dari
inti Chromatin
dlm RBC
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( From Cines DB et al, Immune Thrombocytopenic Purpura, In : N Engl J med 2002 ; 346 )
LABORATORY FINDINGS 9
Low platelet count
Giant platelet
Hemoglobin maybe decreased if there have been
profuse bleeding
BMP : normal granulocytic & erythrocyte series
with characteristically normal or increased
numbers of megakaryocytes, some of the
megakaryocytes may appear to be immature
Platelet antibody (+)
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TREATMENT 10
Intravenous Immunoglobulin ( IVIG )
- Dose : 0,8 1 g / kg /day ; 1-2 days
- Expensive and time consuming to administer
- Adverse effect : headaches & vomitting suggestive of
aseptic meningitis
Prednison
- Dose : 1-4 mg / kg / 24 hours ; 2-3 week or until a rise in
platelet count > 20.000 / mm3
IV anti D therapy
- Given to Rh positive individuals
- Dose : 50 mikrogram / kg
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Splenectomy
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- The older children ( > 4 years ) with severe ITP
> 1 years ( chronic ITP )
- Life threatening hemorrhage ( intracranial
hemorrhage ), if the platelet count cannot
rapidly be corrected with tranfusion of platelets
and administration of IVIG and corticosteroids
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NEONATAL ALLOIMMUNE
THROMBOCYTOPENIA ( NATP )
Caused by the development of maternal antibodies
against antigens present on fetal platelets that are
shared with the father and recognized as foreign
by the maternal immune system
platelet equivalent of Rh disease of the
newborn
1 in 4000 5000 live births
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CLINICAL MANIFESTATIONS 13
Generalized petechiae & purpura within the first few
days after delivery
Normal maternal platelet count, moderate to severe
thrombocytopenia in the newborn
No maternal thrombocytopenia in the past
30 % severe NATP may develop intracranial
hemorrhage
Early jaundice occurs in 20 % of cases as a results of
resolution of intracranial or intraorgan hemorrhage
The thrombocytopenia is transient, lasting up to 3 to
6 weeks
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DIAGNOSIS 14
Checking for the presence of maternal
alloantibodies directed against the fathers platelets
Specific studies to identify the target alloantigen
DIFFERENTIAL DIAGNOSIS
Transplacental transfer of maternal antiplatelet
auto antibodies ( Maternal ITP )
Viral or bacterial infection
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TREATMENT 15
Transfusion with antigen negatife patelets
IVIG = IV IMMUNOGLOBULIN, ( 1 g / kg /24 hours,
PREVENTION
IVIG 1 g / kg /week from midgestation until near
term
Delivery should be performed by cesarean
section
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Terima Kasih
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