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KEYWORDS
girl aged 5 years old
red spots on her arm, lower extremities
and abdomen
blood coming out from her anus
no fever
Previous cough and rhinorrhea, 6 days
ago.
TERMS CLARIFICATION
Hemorrhage:the escape blood from the vessel.
Petechia : a red spot due to escape of a small of blood.
Purpura
: a small hemorrage in the skin,mucous
membrane, or
serous surface.
Ecchymoses:a small hemorrhagic spot in the skin or a
mucous
membrane, larger than a petechia,
forming a
nonelevated, rounded, or irregular
blue or purplish
patch.
Melena
: the passage of dark stools stained with
altered blood by
the intestinal juices.
Hematochezia : the passage of red bloody stools
QUESTIONS
How is the mechanism of
hemostasis?
How hemmorhage or bleeding can
occur?
What is the correlation of previous
disease with the symptom?
Differential diagnosis and their
description.
HEMOSTASIS
BLOOD COAGULATION
FIBRINOLYSIS 1
FIBRINOLISIS 2
INTRINSIK
XIIa
KALIKREIN
EKSTRINSIK
EKSOGEN
t-PA
UROKINASE
AKTIVATOR
PLASMINOGEN
PLASMINOGEN
TERIKAT
PLASMINOGEN
BEBAS
PLASMIN
TERIKAT
FIBRIN
FDP
PLASMIN
BEBAS
FIBRINNOGEN
FV
F VIII
ANTI PLASMIN
HEMORRHAGE?
Vascular abnormality
Thrombocyte abnormality
Coagulation abnormality
Deficiency vitamin K
Trauma
DIFFERENTIAL
DIAGNOSIS
Disseminated Intravasucular
Coagulation
Idiophatic Thrombocytopenic
Purpura
Henoch Schoenlein Syndrome
von Willebrand Disease
Hemophilia A
TABLE
DIC ITP
HENOCH
SCHOENLI
EN
SYNDROME
VONEWILL HEMOPHILIA
EBRAND
A
SYNDROME
PETECHIA
+
(PURPURA)
HEMATOCHEZ
IA
+/-
+/-
+/-
+/-
NO FEVER
PREVIOUS
COUGH &
RHINORRHEA
CHILDREN 5
Y.O
DISSEMINATED
INTRAVASCULAR
COAGULATION
Definition
Disseminated intravascular coagulation (DIC) is a
complex systemic thrombohemorrhagic disorder
involving the generation of intravascular fibrin
and the consumption of procoagulants and
platelets.
DIC is a syndrome arising as a complication of
many different serious and life-threatening
illnesses.
CONT
Synonim: Consumption coagulopathy ,
Hiperfibrinolytic activation,
defibrination and
thrombohemorragic disorder
ET IOLOGY
Obstretical complication:
- abruptio placentae
- amniotic fluid embolism
- dead fetus syndrome
- Septic abortion
Trauma : - burns
Infection: - bacteria
Sepsis
- viral
viremia
Immunologic = Blood transfusion mistake
Malignancy, example : Leukemia
PATOMECANIS
M
Precipitating Mechanism
Tissue damage
damage
Tissue tromboplastin
intrinsic
(F III)
coagulation
Extrinsic pathway of
plasma
Coagulation
Endothelial
Stimulate
pathway of
(F. XII from blood
protein)
Disseminated
Coagulation process
Occlusion
Consumption
blood vessel
factor
Tissue ischemic
/organs +++
Reduce:
FDP
- platelet
Necrosis
Fibrinolysis >>(Homeostasis)
- Coagulation factor
coagulation inhibited
Bleeding
CLINICAL
SYMPTOMS
LABORATORY FINDING
Blood shows an abnormalities coagulation because of fibrinogen
deficiency.
Hemostatic Examination :
1. Platelet count decreased
2. Decreased fibrinogen level
3. Prolonged prothrombin time, activated partial
thromboplastin time, thrombin time
4. Increased levels of FDP ( on testing for FDP, D-dimer)
5. Schistocytes on peripheral smear
TREATMENT
1. Individual treatment
- Treatment closely with the etiology, ages, and hemodinamic situation.
- Determine the underlying cause of the patient's DIC and initiate
therapy
2. General:
a. Monitor vital signs and attend to life-threatening issues such as airway
compromise
Henoch Schoelein
Syndrome
Henoch Scholein
Syndrome
Etiology
Idiopatik
Immune reaction
IgA
Infection
Virus or bakteria
Herediter
Drugs allergy
Insect bitting
Food
Clinical Manifestation
Rash
Purpura (ex : Petechiae )
Abdominal pain
Poliatralgia + Joint swelling
Gastrointestinal bleeding
Renal / Kidney Disease
CNS manifestation
Patomechanism
Etiology of HSS
Increased production of IgA
IgA spreading out and gathered at the
peripehral vaskuler wall
Disturbing and Altering the vaskular
endotel cell main function
Patomechanism
Endotel cell stimulates chemical mediator,
such as TNF alfa and IL 8
Increased of an abnormal apoptosis of
endotelial cell
Neutrofil and limfosit infiltration
Inflamation
Supportive Test
Laboratorium :
Radiography
Therapy
Bed rest + Supportive care
Self Limiting disease
(resolve in 6 8 weeks)
Immunosuppresan
Cyclophosphamide
Corticosteroid
NSAID (Non Steroid Anti Inflamation Drugs)
- Dapsone
Idiopathic
Trombocytopenic
Purpura
Bleeding, petechie / ekimosis on
the skin or(ITP)
mucous membrane
Classification
Acute
: children 2-8 years old,
85 90%
Chronic
: adults 15-50 years
old, 10 15%
Acute ITP
Incidence -> age : 2 8 years old
Female > Male = 4 : 3 or 2 : 1
Patomechanism
Autoantibody IgG binding on the platelet surface
Platelet sensitated
Treatment
Some patients -> Spontaneous
remision
Severe -> corticosteroid
Intravenous heparin
Transfusion of trombocyte
suspension
Ethiology
Idiopathic
Hipersplenism, viral infection, food,
Drugs : asetosal, paraaminosalisilat,
fenulbutasol, diamoks, kina, sidermit
Chemical materials
Malnutrition -> lack of maturation
factor