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Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
Bleeding
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Bleeding

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  • 1. Hemorrhagic Diathesis<br />Causes:<br />Increased fragility of vessels<br />Platelet deficiency or dysfunction<br />Derangement of coagulation<br />
  • 2. Vessel Wall Abnormalities<br />Common but bleeding is LESS Serious<br />Normal Coagulation test<br />1. Microbial damage to Microvasculature or DIC<br />2. Scurvy – Impaired formation of collagen needed for vessel wall support<br />
  • 3. 3. Drugs – immune complex deposits in vessel wall<br />4. Hemoch-Scheonleinpurpura – unknown systemic hypersensitivity disease involve vessels throughout the body &amp; glomerularmesangium<br />5. Amyloid Infiltration of blood vessels – weakens the wall <br />Vessel Wall Abnormalities<br />
  • 4. R/T THROMBOCYTOPENIA<br />Decrease production<br />Aplastic anemia<br />Leukemias<br />Megalobalstic anemia<br />Decrease platelet survival<br />Immune – mediated<br />Non-immune – mechanical <br />
  • 5. Sequestration – seen in marked splenomegaly<br />Dilutional – blood stored &gt; 24hours has less viable platelets<br />R/T THROMBOCYTOPENIA<br />
  • 6. Idiopathic Immune Thrombocytopenic Purpura ( Autoimmune )<br />1. Acute<br />Self-limited Hgicdisease<br />Resolve w/in 6mos.<br />Children after Viral infxn 2 week later  Sudden petechiae, purpura<br />Risk for cerebral bleed<br />Severe cases Tx w/ corticosteroids<br />
  • 7. 2. Chronic<br />Adults women &lt; 40y/o<br />Associated with<br />Collagen Vascular Disease<br />CLL<br />HIV<br />Repeated episodes of Bleeding<br />Tx Steroids. IgG, Splenectomy in severe cases<br />Idiopathic Immune Thrombocytopenic Purpura ( Autoimmune )<br />
  • 8.
  • 9. Deposition of Ig fragments in Amyloidosis<br />
  • 10.
  • 11.
  • 12.
  • 13. Thrombotic Microangipathies<br />I. Thrombotic Thrombocytopenic Purpura<br /> 1. Fever<br /> 2. Thrombocytopenia<br /> 3. Microangioapthic hemolytic anemia<br /> 4. Transient Neurological damage<br /> 5. Renal Failure<br />Deficiency of ADAMTS 13 enzyme<br />Results to accumulation of VHMW vWF promote widesopread platelet Microaggregation<br />
  • 14. II. Hemolytic –Uremic Syndrome<br /> 1. MicroangiopathicHemolytic anemia<br /> 2. Thrombocytopenia<br /> 3. Prominence of renal failure<br /> 4. No Neurological damage<br />Hx of Enteric infection E. coli<br />Release of Shiga –like toxin  Absorbed in GIT  Binds and Damage endothelial cells in Glomerulus &amp; other sites  Platelet Activation &amp; Aggregation<br />Thrombotic Microangipathies<br />
  • 15. Widespread formation of hyaline thrombi in microcircualtion<br />Platelet consumption &amp; Intravascular thrombi<br />Microangiopathic hemolytic anemia<br />Multiple Organ failure<br />Activation of coagualtion cascades is NOT OF PRIMARY IMPORTANCE<br />PT/PTT – usually Normal<br />Thrombotic Microangipathies<br />
  • 16. Plasmin Act.<br />Proteolysis of clotting facotrs<br />

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