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Chapter 15+17 Hemorrhagic Disease & Thrombocytopenic Purpura
Chapter 15+17 Hemorrhagic Disease & Thrombocytopenic Purpura
General Consideration of
Hemorrhagic Disease
Hemostatic mechanism
Coagulation factors
Platelet factors
Classification of hemorrhagic disease
1. Vascular disorders
Hereditary : hereditary telangiectasia
Acquired: hypersensitivity purpura
2. Platelet disorders
Thrombocytopenia :
Decreased platelet production: aplastic anemia
Increased platelet destruction:
idiopathic thrombocytopenic purpura
Platelet depletion:
disseminated intravascular coagulation.
Sequestration of platelet: hypersplenism.
Thrombocytosis:
Primary thrombocytosis
Qualitative platelet disorders
3. Disorder of blood coagulation
Hereditary: hemophilia
Acquired: vitamin K deficiency
4. Disorder of anticoagulation and fibrinolysis
Excessive heparin
Chapter 12
autoimmune disorder
2.Splenectomy
indication:
intolerance to prednisone
51
Cr radio-exponent in spleen area increases
Bleeding
Thromboembolism
Shock
Microangiopathic hemolysis
· Diagnosis criteria
1. clinical criteria
(1) Underlying disorder that has given rise to DIC.
(2) Two or more of following disorder
Multiple sites bleeding,
Shock,
Multiple microvascular thrombosis,
Effective anticoagulating therapy
2. laboratory finding criteria
(1) PLT < 100 × 109/L or continuing decrease
(2) Fibrinogen < 1.5 g/L or continuing decrease
or > 4g/L
(3) 3P(+) or FDP > 20 mg/L, or D-dimer ↓
(4) PT prolong or shorten > 3 s,
APTT prolong or shorten >10s
Differential Diagnosis
Liver disease
Thrombotic thrombocytopenic purura
Treatment
1. Treatment of underlying disease
2. Anticoagulating therapy
Heparin:10000-30000u/d
Indication : (1) stage of high coagulation
(2) DIC is producing serious clinical
consequences and the underlying
cause is not rapidly reversible
Contraindication: (1) surgery
(2) severe bleeding
(3) DIC caused by venin
Monitor: APTT prolong 60%-100%
3.Replacement therapy
Platelet transfusion
Fibrinogen
Fresh plasma
4. Antifibrinolytic therapy
The end