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Hemorrhagic Diathesis
Causes:
Increased fragility of
vessels
Platelet deficiency or
dysfunction
Derangement of
coagulation
Vessel Wall Abnormalities
Common but bleeding is LESS
Serious
Normal Coagulation test
1. Microbial damage to
Microvasculature or DIC
2. Scurvy – Impaired formation of
collagen needed for vessel wall
support
3. Drugs – immune complex deposits in vessel wall
4. Hemoch-Scheonlein purpura –unknown systemic
hypersensitivity diseaseinvolve vessels throughout the body & glomerular mesangium
5. Amyloid Infiltration of blood vessels – weakens the wall
Vessel Wall Abnormalities
R/T THROMBOCYTOPENIA
Decrease production
Aplastic anemia
Leukemias
Megalobalstic anemia
Decrease platelet survival
Immune – mediated
Non-immune – mechanical
Sequestration – seen in marked
splenomegaly
Dilutional – blood stored > 24hours has
less viable platelets
R/T THROMBOCYTOPENIA
Idiopathic Immune
Thrombocytopenic
Purpura ( Autoimmune )
1. Acute
Self-limited Hgic diseaseResolve w/in 6mos.
Children after Viral infxn 2 week
later Sudden petechiae,
purpura
Risk for cerebral bleed
Severe cases Tx w/
corticosteroids
2. Chronic
Adults women < 40y/o
Associated withCollagen Vascular Disease
CLL
HIV
Repeated episodes of Bleeding
Tx Steroids. IgG, Splenectomy in
severe cases
Idiopathic Immune
Thrombocytopenic
Purpura ( Autoimmune )
Deposition of Ig
fragments in
Amyloidosis
Thrombotic Microangipathies
I. Thrombotic Thrombocytopenic
Purpura1. Fever
2. Thrombocytopenia
3. Microangioapthic hemolytic anemia
4. Transient Neurological damage
5. Renal Failure
Deficiency of ADAMTS 13 enzyme
Results to accumulation of VHMW vWF
promote widesopread platelet
Microaggregation
II. Hemolytic –Uremic Syndrome1. Microangiopathic Hemolytic anemia
2. Thrombocytopenia
3. Prominence of renal failure
4. No Neurological damage
Hx of Enteric infection E. coli
Release of Shiga –like toxin Absorbed in
GIT Binds and Damage endothelial cells in
Glomerulus & other sites Platelet Activation
& Aggregation
Thrombotic Microangipathies
Widespread formation of hyaline
thrombi in microcircualtion
Platelet consumption & Intravascular
thrombi
Microangiopathic hemolytic anemia
Multiple Organ failure
Activation of coagualtion cascades is
NOT OF PRIMARY IMPORTANCE
PT/PTT – usually Normal
Thrombotic Microangipathies
Plasmin Act.
Proteolysis of
clotting facotrs
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