This document discusses various bleeding disorders including:
- Definition as a disorder characterized by spontaneous or excessive bleeding following trauma.
- Etiologies including vessel wall abnormalities (congenital or acquired like vasculitis) and platelet functional disorders.
- Specific disorders discussed in more detail include von Willebrand disease, hemophilia, Bernard-Soulier syndrome, and Glanzmann's thrombasthenia.
- Clinical features, laboratory findings, and treatment approaches are provided for many of the disorders.
Aplastic anemia is one of the stem cell disorder which leads to pancytopenia in the peripheral blood and decrease production of all cell line in bone marrow. it require bone marrow transplantation to cure the patient.
Von Willebrand Disease is the most common hereditary bleeding disorder; roughly 1 in every 100 people suffers from the disease. People who suffer from VWD have blood that does not clot properly.
Normally when a person is injured and starts to bleed, the von Willebrand factor in the blood attaches to small blood cells called platelets. This helps the platelets stick together to form a clot at the site of the injury and stop bleeding. When a person has VWD, the clot might take longer to form or not form the way it should and bleeding might take longer to stop. This can lead to heavy, hard-to-stop bleeding. Although rare, the bleeding can be severe enough to damage joints or internal organs, or even be life-threatening.
http://www.nlm.nih.gov/medlineplus/plateletdisorders.html#cat1
http://www.cdc.gov/ncbddd/vwd/facts.html
Aplastic anemia is one of the stem cell disorder which leads to pancytopenia in the peripheral blood and decrease production of all cell line in bone marrow. it require bone marrow transplantation to cure the patient.
Von Willebrand Disease is the most common hereditary bleeding disorder; roughly 1 in every 100 people suffers from the disease. People who suffer from VWD have blood that does not clot properly.
Normally when a person is injured and starts to bleed, the von Willebrand factor in the blood attaches to small blood cells called platelets. This helps the platelets stick together to form a clot at the site of the injury and stop bleeding. When a person has VWD, the clot might take longer to form or not form the way it should and bleeding might take longer to stop. This can lead to heavy, hard-to-stop bleeding. Although rare, the bleeding can be severe enough to damage joints or internal organs, or even be life-threatening.
http://www.nlm.nih.gov/medlineplus/plateletdisorders.html#cat1
http://www.cdc.gov/ncbddd/vwd/facts.html
This would give an idea of the various bleeding disorders, associated clotting factors and more specifically management in the dental office of the patients with bleeding disorders
chronic myeloid leukemia, CML, epidemiology, BCR ABL1 gene, philadelphia chromosome, t(9;22), CML incidence, etiology of CML, pathophysiology of CML, phases of CML, treatment of CML, Allogenic stem cell transplant, TKI therapy for CML, Sokal index for CML,
INTRODUCTION
• Blood must be maintained in a fluid state in order to function as a transport system, but must be able to solidify to form a clot following vascular injury.
• Successful haemostasis is achieved by complex interactions between vascular endothelium, platelets, coagulation factors etc.
HAEMOSTASIS
• The term haemostasis is derived from the Greek word haem= blood and stasis=halt.
• Process of stoppage of bleeding after blood vessels are punctured , cut , or otherwise damaged.
• It is a complex natural physiological response.
• Bleeding disorders are due to altered ability of blood vessels, platelets , and coagulation factors to maintain haemostasis.
• Steps of natural haemostasis:
• Pre-injury conditions-> Early haemostatic response-> Fibrin clot formation-> Limiting clot formation-> Fibrinolysis
Approach to a bleeding disorder: These presentation has the approach for a patient of bleeding disorder. it has History, physical finding, Investigations.
This would give an idea of the various bleeding disorders, associated clotting factors and more specifically management in the dental office of the patients with bleeding disorders
chronic myeloid leukemia, CML, epidemiology, BCR ABL1 gene, philadelphia chromosome, t(9;22), CML incidence, etiology of CML, pathophysiology of CML, phases of CML, treatment of CML, Allogenic stem cell transplant, TKI therapy for CML, Sokal index for CML,
INTRODUCTION
• Blood must be maintained in a fluid state in order to function as a transport system, but must be able to solidify to form a clot following vascular injury.
• Successful haemostasis is achieved by complex interactions between vascular endothelium, platelets, coagulation factors etc.
HAEMOSTASIS
• The term haemostasis is derived from the Greek word haem= blood and stasis=halt.
• Process of stoppage of bleeding after blood vessels are punctured , cut , or otherwise damaged.
• It is a complex natural physiological response.
• Bleeding disorders are due to altered ability of blood vessels, platelets , and coagulation factors to maintain haemostasis.
• Steps of natural haemostasis:
• Pre-injury conditions-> Early haemostatic response-> Fibrin clot formation-> Limiting clot formation-> Fibrinolysis
Approach to a bleeding disorder: These presentation has the approach for a patient of bleeding disorder. it has History, physical finding, Investigations.
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Approach to Pancytopenia with cases.pptxYogeetaTanty1
Approach to pancytopenia with case based discussion and brief details regarding each condition. Causes of pancytopenia. Details of congenital causes of aplastic anemia.
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired, life-threatening disease of the blood characterized by destruction of red Blood cells by the complement system, a part of the body's innate immune system.
The disease is characterized by destruction of red blood cells (hemolytic anemia), blood clots (thrombosis), and impaired bone marrow function (not making enough of the three blood components). It has been known to result from somatic mutations in the PIGA gene, which encodes phosphatidylinositol glycan class A (PIGA).Most treatments for PNH aim to reduce symptoms and prevent complications.
aplastic anemia pediatrics
It compromises a group of disorders of the hematopoietic stem cells resulting in the suppression of one or more of erythroid, myeloid and megakaryotic cell lines.
thrombocytopenia
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. BLEEDING DISORDERBLEEDING DISORDER
• Definition:Definition:
• Disorder characterized by spontaneous/Disorder characterized by spontaneous/
excessive bleeding following trauma.excessive bleeding following trauma.
• Etiology:Etiology:
• A.VESSEL WALL ABNORMALITIES:A.VESSEL WALL ABNORMALITIES:
• Vessel wall abnormalities may beVessel wall abnormalities may be
congenital OR acquired i-e vasculitiscongenital OR acquired i-e vasculitis
may result in purpuric lesions.may result in purpuric lesions.
4. HERIDITARY HEOMORRAGICHERIDITARY HEOMORRAGIC
TELANGECTSIASIS:TELANGECTSIASIS:
• Dominant inherited condition. There is aDominant inherited condition. There is a
telengectiasis and small aneurysms found ontelengectiasis and small aneurysms found on
finger tips, face, nasal passages, tongue andfinger tips, face, nasal passages, tongue and
GIT.GIT.
• Small group of people develop pulmonary A/V :Small group of people develop pulmonary A/V :
anemia due to occult GIT bleeding.anemia due to occult GIT bleeding.
• Rx.Rx.
• Iron therapy for blood loss.Iron therapy for blood loss.
• Local cautery/laser therapy for single lesion fromLocal cautery/laser therapy for single lesion from
bleeding (epistaxis).bleeding (epistaxis).
• Estrogens may be tried.Estrogens may be tried.
5. EHLERS DANLOS DISEASE:EHLERS DANLOS DISEASE:
• Congenital disorder of collagen synthesisCongenital disorder of collagen synthesis
in which capillaries are poorly supportedin which capillaries are poorly supported
by s/c collagen and ecchymosis areby s/c collagen and ecchymosis are
commonly observed.commonly observed.
6. B.PLATELETS FUNCTIONALB.PLATELETS FUNCTIONAL
DISORDER:DISORDER:
• Thrombocytopenia (quantitative plateletsThrombocytopenia (quantitative platelets
dysfunction)dysfunction)
• S/S:S/S:
– Dominated clinically by petechialDominated clinically by petechial
cutaneous bleeding, intracranialcutaneous bleeding, intracranial
bleeding and arising from mucusbleeding and arising from mucus
membrane/surface.membrane/surface.
• Characterized by decreased plateletsCharacterized by decreased platelets
count and prolong bleeding timecount and prolong bleeding time
7. Management:Management:
• Underlying causeUnderlying cause
• Platelet transfusionPlatelet transfusion
Mechanism of Thrombocytopenia:Mechanism of Thrombocytopenia:
• Failure of megakaryocytic maturation.Failure of megakaryocytic maturation.
• Excessive platelets consumption afterExcessive platelets consumption after
their release into circulation i-e ITP, DICtheir release into circulation i-e ITP, DIC
etc.etc.
• Platelets sequestration in enlargedPlatelets sequestration in enlarged
spleen i-e HYPERSPLEENISMspleen i-e HYPERSPLEENISM
11. IDIOPATHIC THROMBOTICIDIOPATHIC THROMBOTIC
THROMBOCYTOPENICTHROMBOCYTOPENIC
PURPURA.PURPURA.
• Autoimmune antibody IgG is formed againstAutoimmune antibody IgG is formed against
unknown antigen of platelets membrane/surface.unknown antigen of platelets membrane/surface.
• Antipletelet antibody binds to complement,Antipletelet antibody binds to complement,
platelets are not destroyed by direct lysis.platelets are not destroyed by direct lysis.
• Rather destruction takes place in spleen, whereRather destruction takes place in spleen, where
spleenic macrophages with Fc bind to antibodyspleenic macrophages with Fc bind to antibody
coated platelets.coated platelets.
12. Clinical Features:Clinical Features:
In Children:In Children:
• Commonly occur in children, often precipitatedCommonly occur in children, often precipitated
by viral infection and usually self limitedby viral infection and usually self limited
• Pt is systematically well and not febrile.Pt is systematically well and not febrile.
• Present e-c/o mucosal/skin bleeding,Present e-c/o mucosal/skin bleeding,
mennorrhagia, purpura, petechiae.mennorrhagia, purpura, petechiae.
13. • Adults:Adults:
• Commonly effects female.Commonly effects female.
• Ratio 2:1 (male/female ratio)Ratio 2:1 (male/female ratio)
• Peak incidence 20-50 years of age.Peak incidence 20-50 years of age.
• Δ LAB:Δ LAB:
• Hallmark of disease is thrombocytopenia i-eHallmark of disease is thrombocytopenia i-e
platelets below 10,000 /ml.platelets below 10,000 /ml.
• Bone marrow will appear normal.Bone marrow will appear normal.
14. RxRx
• PREDENISONONE:PREDENISONONE: 1-2 mg/kg/day.1-2 mg/kg/day.
• SPLEEN ECTOMY: immunoglobulin 1g/kg/daySPLEEN ECTOMY: immunoglobulin 1g/kg/day
2-3 days.2-3 days.
• DANAZOLE:DANAZOLE:600mg/day response rate is600mg/day response rate is
50%50%
• IMMUNOSUPPERESSIVE DRUGS: i-eIMMUNOSUPPERESSIVE DRUGS: i-e
vincristine, vinblastine, azathioprine,vincristine, vinblastine, azathioprine,
cyclosprin, cyclophosphomide.cyclosprin, cyclophosphomide.
• Prognosis:Prognosis:
• The prognosis for remission is good. Disease isThe prognosis for remission is good. Disease is
initially controlled with prednisolone,initially controlled with prednisolone,
spleenectomy is definite Rx.spleenectomy is definite Rx.
16. TIP:TIP:
THROMBOTICTHROMBOTIC
THROMBOCYTOPENIC PURPURA:THROMBOCYTOPENIC PURPURA:
Def:Def:
• TIP is an uncommon syndrome withTIP is an uncommon syndrome with
microangiopathic hemolytic anemia,microangiopathic hemolytic anemia,
thrombocytopenia and markedly increased LDH,thrombocytopenia and markedly increased LDH,
Non-infectious fever, Neurologic disorder, renalNon-infectious fever, Neurologic disorder, renal
abnormalities are less commonly seen.abnormalities are less commonly seen.
• Pathogenesis may be diff: of von Willibrand’sPathogenesis may be diff: of von Willibrand’s
disease factors clearing protease, in some casedisease factors clearing protease, in some case
antibody directed against protease.antibody directed against protease.
17. Clinical features:Clinical features:
• Primarily in young aged 20-25 yr, slightlyPrimarily in young aged 20-25 yr, slightly
common in female.common in female.
• Pts present with anemia, bleeding, feverPts present with anemia, bleeding, fever
and neurological manifestation.and neurological manifestation.
• Neurological symptoms may be, headNeurological symptoms may be, head
ache, confusion aphasia, alteration inache, confusion aphasia, alteration in
consciousness from lethargy to comeconsciousness from lethargy to come
with more advanced one may see hemiwith more advanced one may see hemi
paresis + seizures.paresis + seizures.
18. LAB:LAB:
• Anemia, reticulocytosis and occasionalAnemia, reticulocytosis and occasional
circulating nucleated cells.circulating nucleated cells.
• Hallmark microangiopathic picture withHallmark microangiopathic picture with
fragmented RBC’s i-e (schistocytes, helmetfragmented RBC’s i-e (schistocytes, helmet
cells, triangle forms) on smear.cells, triangle forms) on smear.
• Thrombocytopenia invariably present.Thrombocytopenia invariably present.
• Hemolysis may be manifested with increasedHemolysis may be manifested with increased
indirect bilirubin, hemoglobinemia, methemindirect bilirubin, hemoglobinemia, methem
albuminia which impart a brown colour toalbuminia which impart a brown colour to
plasma.plasma.
• LDH markedly increased.LDH markedly increased.
• Coomb’s test –ve.Coomb’s test –ve.
• Coagulation test: PT, APPTT, fibrinogenCoagulation test: PT, APPTT, fibrinogen
Normal, (fibrin degradation product) FDP mayNormal, (fibrin degradation product) FDP may
be elevatedbe elevated..
19. • Rx:Rx:
• Plasmapheresis with /without prednisone antiPlasmapheresis with /without prednisone anti
platelets aspirin 325 mg/daily , dipyridamole 75platelets aspirin 325 mg/daily , dipyridamole 75
mg × TDS may be given.mg × TDS may be given.
• Combination spleenectomy, steroids andCombination spleenectomy, steroids and
dextran may be used with success.dextran may be used with success.
• Immuno suppressive therapy i-eImmuno suppressive therapy i-e
(cyclophosphomide(cyclophosphomide ).).
• Prognosis:Prognosis:
• 80-90 % Pts recover completely with plasma80-90 % Pts recover completely with plasma
pharesis while 20% pts will be chronic andpharesis while 20% pts will be chronic and
relapsing.relapsing.
21. BERNARD SOULIER SYNDROME:BERNARD SOULIER SYNDROME:
• Bare Autosomal recessive intrinsic plateletsBare Autosomal recessive intrinsic platelets
disorder.disorder.
• Occurs due to lack of glycoprotein (41 b)Occurs due to lack of glycoprotein (41 b)
receptor for von Willibrand’s factor whichreceptor for von Willibrand’s factor which
mediates platelets adhesions to submediates platelets adhesions to sub
endothelium.endothelium.
• Clinical Features:Clinical Features:
• Presents with mucosal bleeding and postPresents with mucosal bleeding and post
operatively as well.operatively as well.
• LAB:LAB:
• Thrombocytopenia may be present, andThrombocytopenia may be present, and
abnormally large.abnormally large.
• BT is prolongedBT is prolonged
• Von Willibrand’s factor NormalVon Willibrand’s factor Normal
• Rx:Rx:
22. GLANSMANN’sGLANSMANN’s
THROMBASTHENIA:THROMBASTHENIA:
• Rae Autosomal recessive disorder.Rae Autosomal recessive disorder.
• Platelets unable to aggregate b/c lack ofPlatelets unable to aggregate b/c lack of
receptors (containing glycoprotein II b + III a)receptors (containing glycoprotein II b + III a)
for fibrinogen which bridges b/w the plateletsfor fibrinogen which bridges b/w the platelets
during aggregation.during aggregation.
• Clinical Features:Clinical Features:
• Mucosal bleedingMucosal bleeding
• LAB:LAB:
• Platelets no’s and morphology are normalPlatelets no’s and morphology are normal
• B.T is prolongedB.T is prolonged
• Platelets fails to aggregate in respond to typicalPlatelets fails to aggregate in respond to typical
against (ADP, collagen, thrombin) butagainst (ADP, collagen, thrombin) but
aggregate in respond to risocetin by separateaggregate in respond to risocetin by separate
mechanismmechanism
• RxRx::
• Platelet transfusionPlatelet transfusion
23. VON-WILLIBRAND’SVON-WILLIBRAND’S
DISEASE:DISEASE:
• It’s a transmitted by Autosomal dominant andIt’s a transmitted by Autosomal dominant and
gene for (VWF) is located on chromosome 12gene for (VWF) is located on chromosome 12
• VWF is synthesized by endothelial cells andVWF is synthesized by endothelial cells and
megakaryocytic that performs two functionsmegakaryocytic that performs two functions
– It acts as carrier protein for factor VIII whichIt acts as carrier protein for factor VIII which
it is non-covalently bound. A deff: thereforeit is non-covalently bound. A deff: therefore
leads to decreased plasma factor VIII level.leads to decreased plasma factor VIII level.
– It form bridges b/w platelets and subIt form bridges b/w platelets and sub
endothelium eg collagen allowing platelets toendothelium eg collagen allowing platelets to
adhere to damaged vessel walls. There foreadhere to damaged vessel walls. There fore
decreased diff: of VWF leads to prolongdecreased diff: of VWF leads to prolong
bleeding after minor trauma.bleeding after minor trauma.
24. • Clinical Features:Clinical Features:
• Mucosal bleeding as already discussed.Mucosal bleeding as already discussed.
• LAB:LAB:
• Reduced level of VWF which of lienReduced level of VWF which of lien
accomplished by sec: reduction in factor VIIIaccomplished by sec: reduction in factor VIII
and prolonged bleeding time (B.T)and prolonged bleeding time (B.T)
• Rx:Rx:
• MILD HAEMORRHAGES:MILD HAEMORRHAGES:
• Desmopressin 0.3 μg/kg, after which VWFDesmopressin 0.3 μg/kg, after which VWF
levels usually raise 3 in 30-90 minuteslevels usually raise 3 in 30-90 minutes
• MASSIVE HAEMORRHAGES:MASSIVE HAEMORRHAGES:
• Factor VIIIFactor VIII
25. C. COAGULATION DISORDER:C. COAGULATION DISORDER:
• Coagulation factor disorder can either canCoagulation factor disorder can either can
either arise from single factor usuallyeither arise from single factor usually
“congenital deficiency” eg factor VIII resulting“congenital deficiency” eg factor VIII resulting
in HAEMOPHILCIA-A or multiple factor which isin HAEMOPHILCIA-A or multiple factor which is
acquired eg Sec: to liver disease or warfarinacquired eg Sec: to liver disease or warfarin
therapy.therapy.
26. CONGENITAL BLEEDINGCONGENITAL BLEEDING
DISORDER:DISORDER:
• HAEMOPHILIAHAEMOPHILIA
• It is hereditary disease affecting malesIt is hereditary disease affecting males
but transmitted by females andbut transmitted by females and
characterized by prolong coagulation andcharacterized by prolong coagulation and
life long tendency to excessivelife long tendency to excessive
hemorrhagehemorrhage
• HEAMOPHILIA – A CLASSIC TRUEHEAMOPHILIA – A CLASSIC TRUE
HAEMOPHILIAHAEMOPHILIA
• X-linked disorderX-linked disorder
• Due deff: of factor VIIIDue deff: of factor VIII
27. • C/F:C/F:
• Although it is congenital disorder bleedingAlthough it is congenital disorder bleeding
occurs as bruising when babies are about 6occurs as bruising when babies are about 6
month old when they begin to move about,month old when they begin to move about,
trauma results in excessively bleeding.trauma results in excessively bleeding.
• Pt with sever hemophilia presents withPt with sever hemophilia presents with
recurrent bleeding hemorrhage at followingrecurrent bleeding hemorrhage at following
sitessites
• Joint most characteristics site is knee, elbow,Joint most characteristics site is knee, elbow,
ankle, and hip.ankle, and hip.
• Mucus membrane internal bleeding of mouth,Mucus membrane internal bleeding of mouth,
lips, gums, brain and kidneylips, gums, brain and kidney
• Muscle haematoma esp. calf and Psoas muscleMuscle haematoma esp. calf and Psoas muscle
• RxRx
• Factor VIII infusionFactor VIII infusion
28. HAEMOPHILLIA – B (CHRISTMASHAEMOPHILLIA – B (CHRISTMAS
DISEASE)DISEASE)
• Due to diff: of factor IXDue to diff: of factor IX
• S/Symptoms:S/Symptoms:
• Same in type ASame in type A
• RxRx
• Factor IX infusionFactor IX infusion
• Long Term ComplicationLong Term Complication
• COMPLICATIONCOMPLICATION due to repeateddue to repeated
hemorrhage:hemorrhage:
• Arthropathy of large joints eg knee, elbowArthropathy of large joints eg knee, elbow
• Muscle atrophy due to haematomaMuscle atrophy due to haematoma
• Mononeuropathy due to pressure ofMononeuropathy due to pressure of
haematoma.haematoma.
• COMPLICATION due to therapyCOMPLICATION due to therapy
• Antifactor VIII antibody developsAntifactor VIII antibody develops
• Virus transmission Hepatitis A-B-C-D + HIVVirus transmission Hepatitis A-B-C-D + HIV
30. DISSAMINATEDDISSAMINATED
INTRAVASCULARINTRAVASCULAR
COAGULATIONCOAGULATION
• DIC is condition characterized by thrombosisDIC is condition characterized by thrombosis
within circulation. DIC can be induced bywithin circulation. DIC can be induced by
variety of diff: mechanism in no: of diverse butvariety of diff: mechanism in no: of diverse but
distinct clinical situations.distinct clinical situations.
• Endothelial cell damage eg endotoxic in G –veEndothelial cell damage eg endotoxic in G –ve
septicemia results in tissue factor release whichsepticemia results in tissue factor release which
in turn leads to coagulation cascade throughin turn leads to coagulation cascade through
extrinsic pathway.extrinsic pathway.
• The presence thromboplastin from damagedThe presence thromboplastin from damaged
tissue, placenta, fat embolus/following braintissue, placenta, fat embolus/following brain
injury may activate coagulationinjury may activate coagulation
• This result in consumption platelets andThis result in consumption platelets and
coagulation factors which secondarily activationcoagulation factors which secondarily activation
of fibrinolysis leading to bleeding tendency.of fibrinolysis leading to bleeding tendency.
32. CancerCancer
• LungLung
• PancreasPancreas
• ProstateProstate
Clinical Features:Clinical Features:
• DIC leads to bleeding, thrombosis,DIC leads to bleeding, thrombosis,
bleeding far from common thanbleeding far from common than
thrombosisthrombosis
• Subacute DIC:Subacute DIC:
• Occurs primarily in cancerous pts resultsOccurs primarily in cancerous pts results
in superficial + deep venous thrombosisin superficial + deep venous thrombosis
33. Other Manifestation:Other Manifestation:
• high incidence of cardio respiratoryhigh incidence of cardio respiratory
failurefailure
LAB:LAB:
• ThrombocytopeniaThrombocytopenia
• Prolong PTProlong PT
• APPTT may be normal/increasedAPPTT may be normal/increased
• Low fibrinogenLow fibrinogen
• Increased level D-dimmerIncreased level D-dimmer
RxRx
• Underlying causeUnderlying cause
34. General Measures:General Measures:
• Correction of dehydration, renal failure,Correction of dehydration, renal failure,
acidosis and shockacidosis and shock
Replacement:Replacement:
• Platelets transfusion if platelets countsPlatelets transfusion if platelets counts
below 10,000μg/lbelow 10,000μg/l
• Fibrinogen with cryoprecipitate toFibrinogen with cryoprecipitate to
maintain plasma fibrinogen level abovemaintain plasma fibrinogen level above
150 mg/dl150 mg/dl
• FFPFFP
• When thrombosis i-e DVT, PulmonaryWhen thrombosis i-e DVT, Pulmonary
their give Heparin.their give Heparin.