The document provides an overview of approaches to thrombocytopenia. It defines levels of thrombocytopenia as mild, moderate or severe based on platelet count thresholds. It discusses factors like prior platelet counts and bleeding risk. Evaluation involves targeted history, repeat CBC, and tests for underlying causes depending on associated findings like fever, organomegaly or neurological symptoms. Thrombocytopenic emergencies requiring immediate referral include bleeding, leukemia or bone marrow failure. Case examples are presented to demonstrate evaluation and management of different thrombocytopenic conditions.
This document describes a case of HIV-associated thrombocytopenia in a 38-year old male patient. He presented with frank hematuria and weakness. Laboratory tests showed thrombocytopenia with a platelet count of 6,000/μl. Further testing revealed the patient was HIV-positive. He was diagnosed with HIV-associated thrombocytopenia and started on oral steroids, antiretroviral therapy, and supplements. Within 4 days his symptoms resolved and his platelet count improved to 70,000, at which point he was discharged. The document then provides background information on HIV-associated thrombocytopenia, its pathophysiology and treatment.
A 27-year-old woman presented with fatigue, shortness of breath, easy bruising, and a syncopal episode. Laboratory workup revealed hemolytic anemia. A bone marrow biopsy showed hypocellular marrow consistent with aplastic anemia and paroxysmal nocturnal hemoglobinuria (PNH). She was treated with immunosuppression but later developed multiple thromboses. Testing confirmed PNH diagnosis. She received eculizumab therapy which stabilized her hemoglobin levels and reduced transfusion requirements. PNH causes hemolytic anemia due to lack of protective proteins on blood cells, predisposing to complement-mediated destruction and thrombosis.
Thrombocytopenia is defined as a platelet count below 150,000/microL. The main causes are decreased platelet production, increased platelet destruction, and altered platelet distribution. Decreased production can result from bone marrow damage, infections, toxins, or drugs. Increased destruction is most common, and can be immune-mediated (as in ITP) or non-immune (as in DIC or TTP). Altered distribution occurs in splenomegaly. Drug-induced thrombocytopenia can occur via direct toxicity, bone marrow suppression, or immune mechanisms like those seen with heparin or abciximab. Pseudo-thrombocytopenia due to platelet clumping must be
This document defines thrombocytopenia as a platelet count below 150,000 per microlitre and discusses its causes, which include increased platelet destruction, decreased platelet production, and other rare conditions. It outlines the workup for thrombocytopenia, including a medical history focusing on medications, physical exam, and lab tests. Treatment depends on the underlying cause but may include treating infections, discontinuing offending drugs, corticosteroids, IVIG, splenectomy, or platelet transfusions in severe cases. The main goals are to identify the cause and treat any underlying condition driving the low platelet count.
This document discusses thrombotic thrombocytopenic purpura (TTP). It begins by presenting a case of a 32-year-old woman presenting with headaches, difficulty speaking and moving her tongue, and numbness. Her exam and labs show thrombocytopenia and schistocytes. The document then discusses the differential diagnosis, epidemiology, terminology, definitions, types, presentations, investigations, and treatment of TTP, with a focus on plasma exchange therapy to remove antibodies and replace deficient ADAMTS13 protease.
This document discusses hemophilia, von Willebrand disease, disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and other platelet disorders. It provides information on the clinical presentation, diagnosis, and treatment of these conditions. Key points include that hemophilia A and B are sex-linked recessive disorders caused by a deficiency in coagulation factors VIII and IX respectively, and DIC is a consumptive coagulopathy caused by excessive thrombin production that requires treatment of the underlying condition.
This document provides an overview of myeloproliferative diseases other than chronic myeloid leukemia. It defines myeloproliferative diseases as disorders characterized by proliferation of one or more hematologic cell lines. The document discusses classifications, clinical presentations, diagnostic criteria, genetic mutations, outcomes, and treatment options for several myeloproliferative diseases including polycythemia vera, essential thrombocythemia, and primary myelofibrosis.
This document describes a case of HIV-associated thrombocytopenia in a 38-year old male patient. He presented with frank hematuria and weakness. Laboratory tests showed thrombocytopenia with a platelet count of 6,000/μl. Further testing revealed the patient was HIV-positive. He was diagnosed with HIV-associated thrombocytopenia and started on oral steroids, antiretroviral therapy, and supplements. Within 4 days his symptoms resolved and his platelet count improved to 70,000, at which point he was discharged. The document then provides background information on HIV-associated thrombocytopenia, its pathophysiology and treatment.
A 27-year-old woman presented with fatigue, shortness of breath, easy bruising, and a syncopal episode. Laboratory workup revealed hemolytic anemia. A bone marrow biopsy showed hypocellular marrow consistent with aplastic anemia and paroxysmal nocturnal hemoglobinuria (PNH). She was treated with immunosuppression but later developed multiple thromboses. Testing confirmed PNH diagnosis. She received eculizumab therapy which stabilized her hemoglobin levels and reduced transfusion requirements. PNH causes hemolytic anemia due to lack of protective proteins on blood cells, predisposing to complement-mediated destruction and thrombosis.
Thrombocytopenia is defined as a platelet count below 150,000/microL. The main causes are decreased platelet production, increased platelet destruction, and altered platelet distribution. Decreased production can result from bone marrow damage, infections, toxins, or drugs. Increased destruction is most common, and can be immune-mediated (as in ITP) or non-immune (as in DIC or TTP). Altered distribution occurs in splenomegaly. Drug-induced thrombocytopenia can occur via direct toxicity, bone marrow suppression, or immune mechanisms like those seen with heparin or abciximab. Pseudo-thrombocytopenia due to platelet clumping must be
This document defines thrombocytopenia as a platelet count below 150,000 per microlitre and discusses its causes, which include increased platelet destruction, decreased platelet production, and other rare conditions. It outlines the workup for thrombocytopenia, including a medical history focusing on medications, physical exam, and lab tests. Treatment depends on the underlying cause but may include treating infections, discontinuing offending drugs, corticosteroids, IVIG, splenectomy, or platelet transfusions in severe cases. The main goals are to identify the cause and treat any underlying condition driving the low platelet count.
This document discusses thrombotic thrombocytopenic purpura (TTP). It begins by presenting a case of a 32-year-old woman presenting with headaches, difficulty speaking and moving her tongue, and numbness. Her exam and labs show thrombocytopenia and schistocytes. The document then discusses the differential diagnosis, epidemiology, terminology, definitions, types, presentations, investigations, and treatment of TTP, with a focus on plasma exchange therapy to remove antibodies and replace deficient ADAMTS13 protease.
This document discusses hemophilia, von Willebrand disease, disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and other platelet disorders. It provides information on the clinical presentation, diagnosis, and treatment of these conditions. Key points include that hemophilia A and B are sex-linked recessive disorders caused by a deficiency in coagulation factors VIII and IX respectively, and DIC is a consumptive coagulopathy caused by excessive thrombin production that requires treatment of the underlying condition.
This document provides an overview of myeloproliferative diseases other than chronic myeloid leukemia. It defines myeloproliferative diseases as disorders characterized by proliferation of one or more hematologic cell lines. The document discusses classifications, clinical presentations, diagnostic criteria, genetic mutations, outcomes, and treatment options for several myeloproliferative diseases including polycythemia vera, essential thrombocythemia, and primary myelofibrosis.
Myeloproliferative disorders include polycythemia vera, essential thrombocytosis, myelofibrosis, and chronic myeloid leukemia. Polycythemia vera is a neoplastic stem cell disorder characterized by erythrocytosis, thrombocytosis, and leukocytosis. Treatment involves phlebotomy and myelosuppressive drugs like hydroxyurea. Essential thrombocytosis is characterized by elevated platelet counts over 600,000 and enlarged, abnormal megakaryocytes. It can cause thrombosis. Myelofibrosis features bone marrow fibrosis, splenomegaly, anemia, and thrombocytopenia. Chronic myeloid leukemia is a malignant disorder caused by the Philadelphia chromosome resulting from a
This case report describes a 3-year-old female patient presenting with bleeding symptoms including rashes, nosebleeds, gum bleeding, and bloody stools. Initial investigations revealed pancytopenia. The peripheral smear and bone marrow findings were suggestive of idiopathic thrombocytopenic purpura with evidence of infection rather than acute promyelocytic leukemia due to the absence of features such as organomegaly and specific immunophenotyping or cytogenetic findings. The patient was treated with antibiotics and supportive care and diagnosed with idiopathic thrombocytopenic purpura complicated by infection based on clinical presentation, investigations, and differential diagnosis workup.
This document provides an overview of bleeding and coagulation disorders. It discusses the components of hemostasis including primary hemostasis mediated by platelets and vessel walls and secondary hemostasis involving the coagulation factors. Common disorders are described such as platelet disorders, hemophilia, and von Willebrand disease. Clinical features and laboratory evaluation including screening coagulation tests are reviewed. Specific conditions like immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura are then explained in more detail covering etiology, pathogenesis, clinical presentation, and diagnosis.
This document summarizes the case of a 32-year-old woman presenting with excessive menstrual bleeding, fatigue, and shortness of breath. Initial testing revealed pancytopenia and hepatosplenomegaly. Bone marrow biopsies showed erythroid hyperplasia and later signs of early myelofibrosis. The patient was ultimately diagnosed with primary myelofibrosis, a rare chronic myeloproliferative neoplasm characterized by bone marrow fibrosis and abnormal growth of blood cells.
Investigations in hemorrhegic disorders ppt Prashant MunePrashant Munde
Clinical assessment, pertinent history, and family history are good indicators for determining patient's bleeding tendencies.
The most appropriate laboratory tests performed are Routine screening tests include a complete blood cell count, platelet count, and evaluation of a peripheral blood sample, a prothrombin time, and an activated partial thromboplastin time.
1. Disseminated intravascular coagulation (DIC) is a condition where excessive blood clotting leads to formation of clots throughout the small blood vessels, consuming clotting factors and platelets and causing bleeding complications.
2. DIC can be caused by infections, cancer, trauma, pregnancy complications, and other medical conditions. It involves an imbalance between coagulation and anticoagulation pathways that leads to thrombosis and hemorrhage.
3. Treatment of DIC focuses on treating the underlying cause, replacing clotting factors, administering anticoagulants in some cases, and restoring natural anticoagulant pathways.
This document discusses thrombocytopenia, defined as a low platelet count. It outlines the pathophysiology as increased platelet destruction often due to antibodies against platelet proteins. Risk factors include certain cancers, toxins, infections, and medications. Signs and symptoms range from bruising to internal bleeding. Diagnosis is via blood tests and physical exam. Treatment depends on severity but may include medications to increase platelets, blood transfusions, or splenectomy. Nursing care focuses on prevention of bleeding and infection.
This document discusses venous thrombosis and pulmonary embolism. It covers risk factors, pathophysiology, diagnostic evaluation, and treatment options. The main points are:
1. Venous thrombosis and pulmonary embolism are concerns in postoperative and ICU patients. Thrombi often form silently in leg veins and can break off and travel to the lungs.
2. Diagnostic evaluations include D-dimer, ventilation-perfusion scans, echocardiograms, angiograms. Imaging shows defects from clots blocking blood flow.
3. Treatment involves anticoagulation initially with heparin or low molecular weight heparin. Warfarin is used long-term. Thrombolytics or inferior v
Leukemia is the most common pediatric malignancy, accounting for 1/3 of all childhood cancers. It is defined as the malignant clonal proliferation of lymphoid or myeloid precursor cells in the bone marrow and infiltration of other organs. The presentation includes general symptoms like fever, fatigue, and pallor as well as hematological effects from bone marrow invasion including anemia, neutropenia, and thrombocytopenia. Diagnosis involves blood tests, bone marrow examination, and other investigations. Treatment consists of induction chemotherapy followed by consolidation and maintenance therapy to achieve remission and prevent relapse.
Pulmonary embolism is a blockage in the lungs caused by blood clots that travel from deep veins, usually in the legs or pelvis. It can be life-threatening and is responsible for around 100,000-200,000 deaths in the US each year. Risk factors include inherited or acquired hypercoagulability, venous stasis, or vessel wall injury. Diagnosis involves assessment of likelihood using scoring systems, blood tests like D-dimer, and imaging tests like CT pulmonary angiogram. Treatment depends on stability but generally involves anticoagulants like heparin or newer oral medications to prevent further clots. Prevention focuses on early mobilization, stockings, and blood thinners for
This document discusses the clinical presentation, management, and treatment of paroxysmal nocturnal hemoglobinuria (PNH). Key points include:
- Common symptoms of PNH include fatigue, dyspnea, hemoglobinuria, abdominal pain, and erectile dysfunction.
- PNH is managed through treatment of anemia, thrombosis, and bone marrow dysfunction. Complement inhibitors like eculizumab and ravulizumab are first-line treatments to reduce hemolysis.
- Special populations like pregnant women and children require modified treatment approaches including continued complement inhibition and thromboprophylaxis during pregnancy.
This document discusses hemostasis, bleeding disorders, and platelet disorders. It begins by explaining normal hemostasis and the mechanisms involved in maintaining a fluid blood state and forming clots at sites of injury. It then defines bleeding disorders as problems with blood clotting that result in abnormal bleeding. Common causes discussed include defects in blood vessels or blood itself, clotting factor deficiencies, platelet abnormalities, and liver disease. Finally, it examines several specific platelet disorders like thrombocytopenia, immune thrombocytopenic purpura, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and those resulting from bone marrow infiltration or disseminated intravascular coagulation.
The document provides information on evaluating and diagnosing thrombocytopenia, including:
1) Normal platelet counts range from 150,000-450,000/microL and are slightly higher in females and younger people. Thrombocytopenia is defined as a platelet count below 150,000/microL.
2) The basic mechanisms of thrombocytopenia include decreased platelet production, ineffective production, increased destruction, increased consumption, and sequestration.
3) Diagnosing thrombocytopenia involves ruling out pseudothrombocytopenia, examining the blood counts, bone marrow, and performing additional lab tests to determine the underlying cause and guide treatment.
Disseminated intravascular coagulation (DIC) is a syndrome characterized by widespread activation of coagulation that can occur as a result of various underlying conditions. It results from an imbalance between coagulation and anticoagulation processes in the body. DIC can be acute, with bleeding and shock being dominant symptoms, or chronic, where thrombosis and clotting may predominate. The most common triggers of DIC are infectious diseases, cancer, obstetric complications, and severe tissue injury. Diagnosis involves identifying symptoms of bleeding and thrombosis, abnormal laboratory coagulation test results, and ruling out other conditions. Treatment focuses on treating the underlying cause, replacing coagulation factors, platelets, and fibrinogen, and
This document discusses thrombocytopenia, defined as a low platelet count. It outlines the pathophysiology as increased platelet destruction often due to antibodies against platelet proteins. Risk factors include certain cancers, toxins, infections, and medications. Signs and symptoms range from bruising to internal bleeding. Treatment involves medications to increase platelet count, transfusions, or splenectomy. Nursing care focuses on prevention of bleeding through careful monitoring and patient education.
This document provides an overview of immune thrombocytopenic purpura (ITP), including its pathogenesis, diagnostic criteria, incidence, physical exam findings, diagnostic testing, differential diagnosis, treatment, and references. ITP is diagnosed based on isolated thrombocytopenia without an alternative cause. It results from increased platelet destruction and inhibited platelet production due to autoantibodies against platelet membrane glycoproteins. Treatment involves glucocorticoids such as prednisone to support platelet counts until remission or more definitive therapy is established.
This document provides an overview of thrombocytopenia, including:
1. A brief history of the identification and study of platelets.
2. Normal platelet kinetics such as production, lifespan, and circulating counts.
3. Causes of thrombocytopenia including decreased production, increased destruction, and sequestration.
4. Evaluation and management of common causes like ITP and TTP, focusing on correlating bleeding risk with platelet counts and treatment options.
The document discusses the interpretation of a complete blood count (CBC) test. A CBC provides information on red blood cells, white blood cells, and platelets. Abnormal CBC results can indicate conditions like infections, anemias, leukemias, and other disorders. The document outlines normal CBC reference ranges and provides guidance on interpreting abnormal high or low blood cell counts based on the specific cell type affected and considering the clinical context.
The patient is a 2 year old male who presents with bruising and petechiae more prominent on the legs. Laboratory tests reveal a normal hemoglobin and white blood cell count with a platelet count of 15,000/mm3. The most likely diagnosis is immune thrombocytopenic purpura (ITP). ITP is an autoimmune disorder causing decreased platelet counts due to platelet destruction by autoantibodies. It commonly presents after a viral illness with bruising and petechiae, and the patient's presentation and laboratory results are consistent with ITP.
Critical limb ischemia refers to severe reduced blood flow in the limbs that puts the extremities at risk for gangrene and amputation. It is usually caused by advanced peripheral artery disease resulting from atherosclerosis. There are two main types - acute limb ischemia which is a surgical emergency requiring urgent revascularization to prevent amputation, typically due to an embolism or thrombosis; and chronic limb ischemia which is caused by progressive atherosclerosis and not an emergency but requires treatment to prevent limb loss. Medical management focuses on risk factor modification through smoking cessation, tight blood pressure and glucose control, and lipid lowering therapy, while exercise is recommended to improve symptoms.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Myeloproliferative disorders include polycythemia vera, essential thrombocytosis, myelofibrosis, and chronic myeloid leukemia. Polycythemia vera is a neoplastic stem cell disorder characterized by erythrocytosis, thrombocytosis, and leukocytosis. Treatment involves phlebotomy and myelosuppressive drugs like hydroxyurea. Essential thrombocytosis is characterized by elevated platelet counts over 600,000 and enlarged, abnormal megakaryocytes. It can cause thrombosis. Myelofibrosis features bone marrow fibrosis, splenomegaly, anemia, and thrombocytopenia. Chronic myeloid leukemia is a malignant disorder caused by the Philadelphia chromosome resulting from a
This case report describes a 3-year-old female patient presenting with bleeding symptoms including rashes, nosebleeds, gum bleeding, and bloody stools. Initial investigations revealed pancytopenia. The peripheral smear and bone marrow findings were suggestive of idiopathic thrombocytopenic purpura with evidence of infection rather than acute promyelocytic leukemia due to the absence of features such as organomegaly and specific immunophenotyping or cytogenetic findings. The patient was treated with antibiotics and supportive care and diagnosed with idiopathic thrombocytopenic purpura complicated by infection based on clinical presentation, investigations, and differential diagnosis workup.
This document provides an overview of bleeding and coagulation disorders. It discusses the components of hemostasis including primary hemostasis mediated by platelets and vessel walls and secondary hemostasis involving the coagulation factors. Common disorders are described such as platelet disorders, hemophilia, and von Willebrand disease. Clinical features and laboratory evaluation including screening coagulation tests are reviewed. Specific conditions like immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura are then explained in more detail covering etiology, pathogenesis, clinical presentation, and diagnosis.
This document summarizes the case of a 32-year-old woman presenting with excessive menstrual bleeding, fatigue, and shortness of breath. Initial testing revealed pancytopenia and hepatosplenomegaly. Bone marrow biopsies showed erythroid hyperplasia and later signs of early myelofibrosis. The patient was ultimately diagnosed with primary myelofibrosis, a rare chronic myeloproliferative neoplasm characterized by bone marrow fibrosis and abnormal growth of blood cells.
Investigations in hemorrhegic disorders ppt Prashant MunePrashant Munde
Clinical assessment, pertinent history, and family history are good indicators for determining patient's bleeding tendencies.
The most appropriate laboratory tests performed are Routine screening tests include a complete blood cell count, platelet count, and evaluation of a peripheral blood sample, a prothrombin time, and an activated partial thromboplastin time.
1. Disseminated intravascular coagulation (DIC) is a condition where excessive blood clotting leads to formation of clots throughout the small blood vessels, consuming clotting factors and platelets and causing bleeding complications.
2. DIC can be caused by infections, cancer, trauma, pregnancy complications, and other medical conditions. It involves an imbalance between coagulation and anticoagulation pathways that leads to thrombosis and hemorrhage.
3. Treatment of DIC focuses on treating the underlying cause, replacing clotting factors, administering anticoagulants in some cases, and restoring natural anticoagulant pathways.
This document discusses thrombocytopenia, defined as a low platelet count. It outlines the pathophysiology as increased platelet destruction often due to antibodies against platelet proteins. Risk factors include certain cancers, toxins, infections, and medications. Signs and symptoms range from bruising to internal bleeding. Diagnosis is via blood tests and physical exam. Treatment depends on severity but may include medications to increase platelets, blood transfusions, or splenectomy. Nursing care focuses on prevention of bleeding and infection.
This document discusses venous thrombosis and pulmonary embolism. It covers risk factors, pathophysiology, diagnostic evaluation, and treatment options. The main points are:
1. Venous thrombosis and pulmonary embolism are concerns in postoperative and ICU patients. Thrombi often form silently in leg veins and can break off and travel to the lungs.
2. Diagnostic evaluations include D-dimer, ventilation-perfusion scans, echocardiograms, angiograms. Imaging shows defects from clots blocking blood flow.
3. Treatment involves anticoagulation initially with heparin or low molecular weight heparin. Warfarin is used long-term. Thrombolytics or inferior v
Leukemia is the most common pediatric malignancy, accounting for 1/3 of all childhood cancers. It is defined as the malignant clonal proliferation of lymphoid or myeloid precursor cells in the bone marrow and infiltration of other organs. The presentation includes general symptoms like fever, fatigue, and pallor as well as hematological effects from bone marrow invasion including anemia, neutropenia, and thrombocytopenia. Diagnosis involves blood tests, bone marrow examination, and other investigations. Treatment consists of induction chemotherapy followed by consolidation and maintenance therapy to achieve remission and prevent relapse.
Pulmonary embolism is a blockage in the lungs caused by blood clots that travel from deep veins, usually in the legs or pelvis. It can be life-threatening and is responsible for around 100,000-200,000 deaths in the US each year. Risk factors include inherited or acquired hypercoagulability, venous stasis, or vessel wall injury. Diagnosis involves assessment of likelihood using scoring systems, blood tests like D-dimer, and imaging tests like CT pulmonary angiogram. Treatment depends on stability but generally involves anticoagulants like heparin or newer oral medications to prevent further clots. Prevention focuses on early mobilization, stockings, and blood thinners for
This document discusses the clinical presentation, management, and treatment of paroxysmal nocturnal hemoglobinuria (PNH). Key points include:
- Common symptoms of PNH include fatigue, dyspnea, hemoglobinuria, abdominal pain, and erectile dysfunction.
- PNH is managed through treatment of anemia, thrombosis, and bone marrow dysfunction. Complement inhibitors like eculizumab and ravulizumab are first-line treatments to reduce hemolysis.
- Special populations like pregnant women and children require modified treatment approaches including continued complement inhibition and thromboprophylaxis during pregnancy.
This document discusses hemostasis, bleeding disorders, and platelet disorders. It begins by explaining normal hemostasis and the mechanisms involved in maintaining a fluid blood state and forming clots at sites of injury. It then defines bleeding disorders as problems with blood clotting that result in abnormal bleeding. Common causes discussed include defects in blood vessels or blood itself, clotting factor deficiencies, platelet abnormalities, and liver disease. Finally, it examines several specific platelet disorders like thrombocytopenia, immune thrombocytopenic purpura, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and those resulting from bone marrow infiltration or disseminated intravascular coagulation.
The document provides information on evaluating and diagnosing thrombocytopenia, including:
1) Normal platelet counts range from 150,000-450,000/microL and are slightly higher in females and younger people. Thrombocytopenia is defined as a platelet count below 150,000/microL.
2) The basic mechanisms of thrombocytopenia include decreased platelet production, ineffective production, increased destruction, increased consumption, and sequestration.
3) Diagnosing thrombocytopenia involves ruling out pseudothrombocytopenia, examining the blood counts, bone marrow, and performing additional lab tests to determine the underlying cause and guide treatment.
Disseminated intravascular coagulation (DIC) is a syndrome characterized by widespread activation of coagulation that can occur as a result of various underlying conditions. It results from an imbalance between coagulation and anticoagulation processes in the body. DIC can be acute, with bleeding and shock being dominant symptoms, or chronic, where thrombosis and clotting may predominate. The most common triggers of DIC are infectious diseases, cancer, obstetric complications, and severe tissue injury. Diagnosis involves identifying symptoms of bleeding and thrombosis, abnormal laboratory coagulation test results, and ruling out other conditions. Treatment focuses on treating the underlying cause, replacing coagulation factors, platelets, and fibrinogen, and
This document discusses thrombocytopenia, defined as a low platelet count. It outlines the pathophysiology as increased platelet destruction often due to antibodies against platelet proteins. Risk factors include certain cancers, toxins, infections, and medications. Signs and symptoms range from bruising to internal bleeding. Treatment involves medications to increase platelet count, transfusions, or splenectomy. Nursing care focuses on prevention of bleeding through careful monitoring and patient education.
This document provides an overview of immune thrombocytopenic purpura (ITP), including its pathogenesis, diagnostic criteria, incidence, physical exam findings, diagnostic testing, differential diagnosis, treatment, and references. ITP is diagnosed based on isolated thrombocytopenia without an alternative cause. It results from increased platelet destruction and inhibited platelet production due to autoantibodies against platelet membrane glycoproteins. Treatment involves glucocorticoids such as prednisone to support platelet counts until remission or more definitive therapy is established.
This document provides an overview of thrombocytopenia, including:
1. A brief history of the identification and study of platelets.
2. Normal platelet kinetics such as production, lifespan, and circulating counts.
3. Causes of thrombocytopenia including decreased production, increased destruction, and sequestration.
4. Evaluation and management of common causes like ITP and TTP, focusing on correlating bleeding risk with platelet counts and treatment options.
The document discusses the interpretation of a complete blood count (CBC) test. A CBC provides information on red blood cells, white blood cells, and platelets. Abnormal CBC results can indicate conditions like infections, anemias, leukemias, and other disorders. The document outlines normal CBC reference ranges and provides guidance on interpreting abnormal high or low blood cell counts based on the specific cell type affected and considering the clinical context.
The patient is a 2 year old male who presents with bruising and petechiae more prominent on the legs. Laboratory tests reveal a normal hemoglobin and white blood cell count with a platelet count of 15,000/mm3. The most likely diagnosis is immune thrombocytopenic purpura (ITP). ITP is an autoimmune disorder causing decreased platelet counts due to platelet destruction by autoantibodies. It commonly presents after a viral illness with bruising and petechiae, and the patient's presentation and laboratory results are consistent with ITP.
Critical limb ischemia refers to severe reduced blood flow in the limbs that puts the extremities at risk for gangrene and amputation. It is usually caused by advanced peripheral artery disease resulting from atherosclerosis. There are two main types - acute limb ischemia which is a surgical emergency requiring urgent revascularization to prevent amputation, typically due to an embolism or thrombosis; and chronic limb ischemia which is caused by progressive atherosclerosis and not an emergency but requires treatment to prevent limb loss. Medical management focuses on risk factor modification through smoking cessation, tight blood pressure and glucose control, and lipid lowering therapy, while exercise is recommended to improve symptoms.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
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2. DEFINITIONS
• Thrombocytopenia is defined as a platelet count below the lower
limit of normal.
Mild
• 100,000 to 150,000/microL
Moder
ate
• 50,000 to 99,000/microL
Severe
• <50,000/microL
3. Pitfalls
• Approximately 2.5 percent populations may have platelet count less
than 150,000/microL
• An individual may present with a significant decrease in platelet
count though still be within the 'normal' range (eg, a drop in platelet
count from 400,000 to 200,000/microL is concerning, even though
the value is still ≥150,000/microL). Such a reduction may be clinically
significant and requires evaluation. At a minimum, the platelet count
should be repeated.
• These issues also highlights the importance of obtaining previous
platelet counts (if available) to determine whether the count is stable
or trending downward.
4. When to worry about bleeding
• The concept of a "safe" platelet count is imprecise, lacks
evidence-based recommendations, and depends on the disorder
and on the patient (even with the same disorder).
• Severe spontaneous bleeding is rare; it is most likely with
platelet counts <20,000/microL, especially <10,000/microL.
5. When to worry about bleeding
- Clinical predictors of bleeding includes
Prior bleeding episodes
Presence of wet purpura and
Haematuria.
6. When to worry about bleeding
• It is also important to consider other factors that may affect bleeding
risk (eg, platelet function defects, coagulation abnormalities).
• Patients with severe liver disease or disseminated intravascular
coagulation may have a greater risk of bleeding from coagulation
defects than from the thrombocytopenia.
7. When to worry about thrombosis
Patients with thrombocytopenia are at risk for thrombosis rather than,
or in addition to, bleeding. Though rare, it is important to consider
them because urgent treatment may be needed to prevent life-
threatening thrombotic events.
1. Heparin-induced thrombocytopenia
2. Vaccine-induced immune thrombotic thrombocytopenia (VITT)
3. Antiphospholipid syndrome
4. Disseminated intravascular coagulation
5. Thrombotic microangiopathy
10. Thrombocytopenia with neurological
symptom and high LDH
MS S N
37 F
Presented with occipital headache, slurring of speech (flactuating), on and off left
sided paraesthesia, LBP
Bruise in arm and shin
New onset thrombocytopenia (30) with anaemia (9.9)
CT brain Normal
Dugue and malaria Negative
DCT negative
LDH 820
INR 1.22, APTT 48, LA-negative, ANA- negative
11. Which single most investigation is important
for diagnosis
A. BMAT
B. PBF
C. MRI of Brain with MRA
D. ADAMTS13
E. Renal profile
12. Thrombocytopenia with anaemia
Mr M S N
27 M
PMH nil
Drug nil
Presentation was generalized weakness and LBP
new onset Severe Thrombocytopenia(68) with anaemia (7.5)
No bleeding/purpura
No organomegaly or lymphadenopathy
13. What should be the next plan?
A. BMAT
B. PBF
C. Haematology referral
D. Send iron and vitamin B12 study
E. Send DCT, LDH
14. Thrombocytopenia with leukopenia
Mr J B K
47 M
Nil PMH
COVID vaccination on 01/07/21 moderna
Presented with palpitation and tremor to AE on 10/07/21
Ref for new onset moderate thrombocytopenia (51) with leukopenia(3.1)
CRP 0.052 Lactate 1.1
Dengue and Malaria negative
PBF Bicytopenia (non diagnostic film)
15. What are the appropriate action for this
patient?
A. Looks for findings of thrombosis
B. Watch and wait for severe thrombocytopenia
C. Send anti PF4 antibody
D. Platelet transfusion
E. IV immunoglobulin
16. Thrombocytopenia, anaemia and obesity
39 M
PMH- DM, HTN,HLP, Asthma, Morbid Obesity 154kg
Exertional dyspnea, lethargy, occ epistaxis and gum bleeding
Chronic moderate thrombocytopenia for 3 years and anaemia
INR 1.50
Albumin 27 g/l
Hep B and C negative
17. Q: what's the likely diagnosis
A. ITP
B. Chronic liver disease
C. CML
D. DITP
18. Isolated thrombocytopenia
• Mr A R H
• 17 M
• Presented with purpura and oral mucosal bleeding-3 days
New onset isolated thrombocytopenia
• Hb 14, WCC 10.7 PLATELET 1
• DCT Negative, LDH 181
• ANA negative
• TFT and LFT- Normal
• Coagulation screen INR 1.1, APTT 30.9
• Viral/infection screen-Malaria Neg, Dengue Neg, CMV Neg, Hep B, C and HIV negative
• CRP 0.7
20. Initial Mandatory Questions
● Is the thrombocytopenia real?
Not a laboratory error, can be done by repeating the CBC and reviewing the
peripheral blood smear
● Is the thrombocytopenia new?
A new reduction is more concerning than a stable because it suggests the
possibility of an evolving condition.
New- BM disorder, DIC, Drugs(Heparin, Vaccine)
Chronic- ITP, CLD, HIV, connective tissue disorder
● Are there other hematologic abnormalities?
Anemia, leukopenia, leukocytosis, coagulation abnormalities generally
suggest a more serious diagnosis than isolated thrombocytopenia
21. Targeted History
- History of bleeding (eg, petechiae, ecchymoses, epistaxis,
hematemesis, melena, heavy menstrual bleeding).
- Infectious exposures, including recent infections (viral, bacterial,
rickettsia), recent travel to an area endemic for malaria, dengue virus,
leptospirosis, rickettsia infections and viral hemorrhagic fevers.
- Medication exposures – It is important to include new prescriptions,
medications that are only taken intermittently, over-the-counter
medicines (eg, aspirin, nonsteroidal anti-inflammatory drugs), herbal
remedies, vaccines
22. Targeted History
- Other medical conditions, including hematologic disorders;
rheumatologic diseases; bariatric surgery or poor nutritional status;
blood product transfusion or organ transplantation
- Prior platelet counts
= Family history of bleeding disorders and/or thrombocytopenia.
23. Relevant findings
Specific diagnoses to consider depend on the other clinical findings. As
examples:
•Fever – Possible infection, sepsis, disseminated intravascular coagulation
(DIC)
•Hepatosplenomegaly – Possible liver disease with hypersplenism,
Leukaemia or lymphoma
•Neurologic findings – Possible TTP, HUS, DITMA, vitamin B12 deficiency
•Lymphadenopathy – Possible infection, lymphoma, other malignancy
•Thrombosis – Possible HIT, antiphospholipid syndrome (APS), or paroxysmal
nocturnal hemoglobinuria (PNH) or VITT
24. LABORATORY TESTING
Repeat CBC and when to do
• For symptomatic patients (eg, signs of bleeding) or those with severe
thrombocytopenia (ie, <50,000/microL), such retesting should be
performed immediately.
• For asymptomatic patients (eg, non-bleeding, no associated
comorbidities) with moderate thrombocytopenia (ie, 50,000 to
100,000/microL), testing may be repeated in one to two weeks,
provided the patient is advised to report immediately any changes in
clinical status or bleeding during this interval.
26. Thrombocytopenic emergencies requiring
immediate haematology referral
• Bleeding in the setting of severe thrombocytopenia
(ie, platelet count <50,000/microL)
• Suspected acute leukemia, aplastic anemia, or other
bone marrow failure syndrome
• Urgently needed invasive procedure with severe
thrombocytopenia
• Pregnancy with severe thrombocytopenia
30. Thrombocytopenia with neurological symptom and high LDH
37 F
Presented with fluctuating neurological symptoms
New onset thrombocytopenia(30) with anaemia(9.9)
CT brain Normal
Dengue and malaria Negative
DCT negative
INR 1.22, APTT 48, LA-negative, ANA- negative
LDH 820
DATE 21/12 22/12 23/12 24/12
PLEX
25/12 26/12 28/12 30/12 01/01 02/01
Platelet 30 23 18 23 35 49 74 77 112 232
LDH 820 963 528 262 241 405 180 280
R
31. Mr M S Z
24 M
Fever, headache, abdominal pain, vomiting and skin rash-4 days
New onset thrombocytopenia (5) and anaemia (Hb 5)
Treated with TPE 10 session and steroid
DATE 03/01 04/01 05/01 06/01 07/01 08/01 09/01 10/01 11/01
Platelet 6 5 9 39 78 117 154 168 180
LDH 2823 2005 1036 535 443 403 269 241 210
R
32. Thrombocytopenia with anaemia
Mr M S N
27 M
PMH nil
Drug nil
Presentation was generalized weakness and LBP
New onset Moderate thrombocytopenia (68) with anaemia (7.5)
No bleeding/purpura
No organomegaly or lymphadenopathy
R
33. Thrombocytopenia with fever
Mrs J S
41 F
Presented with Fever and suprapubic pain on 07/04/2022
Developed hypotension and started inotropes on 08/04/2022
INR 2.41 APTT 36
Lactate 7.3
CRP 2.2(7/4)>13.8(10/4)> 0.536(15/4)
Blood CS E Coli
35. Thrombocytopenia with fever
Mr H A L
38 M
K/C DM, HTN, HLP
Presented with Light headedness, giddiness and vomiting on 13/06/22
Recorded febrile(38.9) in AE
New onset mild thrombocytopenia (106) followed by downtrend upto
20
PBF thrombocytopenia with reactive lymphocyte
Deranged LFT
37. Thrombocytopenia, anaemia and obesity
39 M
PHM DM, HTN, HLP, Asthma, Morbid Obesity 154kg
Exertional dyspnea, lethargy, occ epistaxis and gum bleeding
Chronic thrombocytopenia for 3 years and anaemia
INR 1.50
Albumin 27 g/l
Hep B and C negative
39. Thrombocytopenia with leukopenia
Mr J B K
47 M
Nil PMH
COVID vaccination on 01/07/21 (moderna)
Presented with palpitation and tremor to AE on 10/07/21
Ref for new onset moderate thrombocytopenia (51) with leukopenia(3.1)
CRP 0.052 Lactate 1.1
Dengue and Malaria negative
PBF Bicytopenia (non diagnostic film)
40. Trend of Platelet, MPV and WBC
Date WBC Platelet Mean Platelet
Volume
10/07/2021 3.1 51 9.7
11/07/2021 2.8 40 10.5
12/07/2021 3.4 57 11.6
14/07/2021 3.8 86 11.3
22/07/2021 6.0 456 9.7
R
41. Isolated thrombocytopenia
• Mr A R H
• 17 M
• Presented with rash and oral mucosal bleeding-3 days
New onset isolated thrombocytopenia
• Hb 14, WCC 10.7 PLATELET 1
• DCT Negative, LDH 181
• ANA negative
• TFT and LFT- Normal
• Coagulation screen INR 1.1, APTT 30.9
• Viral/infection screen-Malaria Neg, Dengue Neg, CMV Neg, Hep B, C and HIV negative
• CRP 0.7 IVIG
R
42. Megaloblastic anaemia related
thrombocytopenia
59 M
PMH- HTN, HLP
Presented with epigastric pain and loss of appetite
Macrocytic anaemia (5.9), leukopenia(2.0) and moderate
thrombocytopenia (69)
Vit B12 <109
Iron- 16.6
Anti-parietal cell antibody- positive