coagulopathies and bleeding Disorder

Embed Size (px)

Citation preview

  • 8/10/2019 coagulopathies and bleeding Disorder

    1/39

    !"#$%&"'#()*+, #./ 0&++/*.$ 1*,"2/+2,

    !"#$ &'()"*+ ,-

  • 8/10/2019 coagulopathies and bleeding Disorder

    2/39

    1*,3&",%2+ #./ !".(#3( 4.5"26#7".

    !"#$ &'()"*+ ,--./.*.(0 (1 23$)(0"#4 "05 6#.78"$ 6"#9 ,95.8.09

    -9:"#;)90; (1

  • 8/10/2019 coagulopathies and bleeding Disorder

    3/39

    89:+37;+,

    2$";9$9; -.*(#59#* "05 2$";9$9; "0*13*.(0 EF:$".0 8"3*9* "05 .):$.8"7(0* (1 ;'#()G(84;(:90."

    -9*8#.G9 .05.8"7(0* 1(# :$";9$9; ;#"0*13*.(0

    H98(?0.I9 8$.0.8"$ *405#()9* (1 J.;'>"#1"#.0 "05 0(/9$ (#"$ 8("?3$"7(0 .0'.G.;(#*

    EF:$".0 :#(G$9)* "**(8.";95 >.;' 3*9 (1 LM

  • 8/10/2019 coagulopathies and bleeding Disorder

    4/39

    '( '"/9 ;'#()G(84;(:90." >'.8' :9#*.*;*

    $(0?9# '"/9 .08#9"*95 )(#;"$.;4

    W@8"+ 6#.; 6"#9 ,95+ XRRXY TRDZQT

    K;#"3**+ 6#.; 6"#9 ,95+ XRRXY TRDPZ[Q

  • 8/10/2019 coagulopathies and bleeding Disorder

    5/39

  • 8/10/2019 coagulopathies and bleeding Disorder

    6/39

  • 8/10/2019 coagulopathies and bleeding Disorder

    7/39

    11A>

  • 8/10/2019 coagulopathies and bleeding Disorder

    8/39

    4./*3#7"., 5"2 B(+&+(

  • 8/10/2019 coagulopathies and bleeding Disorder

    9/39

    B(+&+( .;' G.(:*.9* "05 ;'9#":9378.0;9#/907(0*+ A XR+RRRS))T 1(# 5."?0(*78 :#(8953#9*

    6M6+ _3)G"# :308;3#9+ ;'(#"S:"#"890;9*.*+ G(09

    )"##(> G.(:*4D XR+RRRS))T

    k9.5$9#+ "0*13*.(0+ XRPPY QPDXX[l

    M"/#.8@"+ W00 J9)";($ XRRTY ^XDQZR

  • 8/10/2019 coagulopathies and bleeding Disorder

    10/39

    B2"')= B(+&+(

  • 8/10/2019 coagulopathies and bleeding Disorder

    11/39

    B2"')= B(+&+( (#;' 9;C

    "$C \En,+

    XRPTY

    T[^DPZZP

    [RR :"790;*

    >.;'

    '9)";($(?.8

    )"$.?0"084

    H6& ;(

    :#(:'4C ";PR@ (# (0$4

    >.;' G$995.0?

  • 8/10/2019 coagulopathies and bleeding Disorder

    12/39

    o(3 "#9 8(0*3$70? (0 " [^ 4C(C :(*;(:9#"7/9 6Wdb :"790;(0 :(*;A(: 5"4 [ .0 K.;' :9#*.*;90; 6JL ;#9";95 >.;'5.3#978*+ W6EA< "05 301#"87(0";95 '9:"#.0C K'9 .*

    G95G(305C K'9 '"* 30.$";9#"$ $9? 959)" >.;' 5(::$9#3$;#"*(305 *'(>.0? -M&C

  • 8/10/2019 coagulopathies and bleeding Disorder

    13/39

    D+'#2*. 4./%3+/

  • 8/10/2019 coagulopathies and bleeding Disorder

    14/39

    B2+(+,( B2"9#9*&*(= "5 D4< ,"](# H.*@ 1"8;(#* c`H qQf

    J9:"#.0 53#"7(0 qU 5"4*

    H9890; '9:"#.0 c:"*; PRR 5"4*f

    =*9 (1 301#"87(0";95 '9:"#.0

    H.*@ q PV

    2(*; (: :"790; >.;' =LJ c:#(:'4$"878 (# ;'9#":9378f q U 5"4* H.*@ RCPV A PCRV

    ,95.8"$ S (G*;9;#.8 :"790;* =LJ qU 5"4*

    2(*;A(: :"790; >.;' _,aJ q U 5"4*

    H.*@ O RCPV

    ,95.8"$ S (G*;9;#.8 :"790;* _,aJ q U 5"4*

    W04 :"790; #989./.0? =LJ (# _,aJ O U5"4*

    a"#@9070 XRR^+ 6'9*;Y PTTDTURK A T^RK

  • 8/10/2019 coagulopathies and bleeding Disorder

    15/39

    D4< !&*.*3#& E*./*.$,

    2$";9$9; 8(30; 1"$$ q QRV 1#() G"*9$.09 K:98.N8 ;9):(#"$ :"e9#0 cQAPU 5"4* "r9# '9:"#.0

    9F:(*3#9f

    WG*($3;9 :$";9$9; 8(30; O PQR+RRR S ))T A $9** *:98.N8

    W::#(F.)";9$4 PSU (1 :"790;* ;'#()G(*.* :#98959*;'#()G(84;(:90."

    M"#."7(0*

    H":.5 (0*9; J

  • 8/10/2019 coagulopathies and bleeding Disorder

    16/39

    F#9"2#("2= (+,(, 5"2 D4"#1"#.0 a"#1"#.0 *'(3$5 0(; G9 3*95 "$(09 "* .0.7"$ &F a"#1"#.0 *'(3$5 0(; G9 .0.7";95 307$ :$";9$9; 8(30;

    *3G*;"07"$$4 #98(/9#95+ ).0.)3) (/9#$": Q 5"4* \(0A'9:"#.0

  • 8/10/2019 coagulopathies and bleeding Disorder

    18/39

    W XX 4( >()"0 :#9*90;* >.;' '9"5"8'9+ 1"7?39 F T 5"4*CK'9 '"* 1(8"$ 093#( *4):;()* G3; .* *()0($90;C \(#)"$

    :3$*9 "05 d2+ & T^CRC K'9 5(9* 0(; '"/9 038'"$ #.?.5.;4 (#:'(;(:'(G."C [email protected] '"* :9;98'."9 (0 )38(*"$ )9)G#"09*"05 $9?*C d=\S6# [PSTCTY _-J ^UXY ad6 PRCZY J?G i ^Cl?S5_Y 2$";9$9; Pl+RRRS))TC .;' X $4):'(84;9*S ':1C &'9#9 "#9*8'.*;(84;9* (0 :9#.:'9#"$ *)9"#C

    a'"; ;#9";)90; >(3$5 4(3 :3#*39 N#*;p

    Wf 2$"*)" 9F8'"0?9

    df 2$"*)" .013*.(0

    6f 2$";9$9; ;#"0*13*.(0

    -f 69r#."F(09 "05 /"08()48.0 Ef J.?' 5(*9 8(#78(*;9#(.5* "05 ./ .))0(?$(G3$.0

  • 8/10/2019 coagulopathies and bleeding Disorder

    19/39

    466%.+

  • 8/10/2019 coagulopathies and bleeding Disorder

    20/39

    .;'(3; :3#:3#"

    W09)." c).8#("0?.(:";'.8'9)($4*.*f

    H90"$ 1".$3#9 S .0*3s8.9084

    \93#($(?.8 N05.0?*D'9"5"8'9+ "$;9#95 )90;"$*;";3*+ *9.I3#9*

    L9/9#

    ,(#;"$.;4 PRATQV

    -9N8.9084 (1 W-W,&KAPT'e:DSS>TC(3'*8C953S:$";9$9;*S2$";9$9;

    VXR2.8*S2$";9$9;*XC]:?

  • 8/10/2019 coagulopathies and bleeding Disorder

    21/39

    F#9"2#("2= E+#(%2+, #./ .;' *8'.*;(84;9*

    6(0*3):7(0 (1 8("?3$"7(0 :#(;9.0* \`& " 19";3#9

    6("?3$"7(0 "G0(#)"$.79* ).$5

    -.m9#907"$ 5."?0(*.*D J=KW3;(.))309 '9)($478 "09)."+ )"$"#."+ JE__2 *405#()9+

    "07:'(*:'($.:.5 WG+ -

  • 8/10/2019 coagulopathies and bleeding Disorder

    22/39

  • 8/10/2019 coagulopathies and bleeding Disorder

    23/39

    D+6"&=73 J2+6*3 C=./2"6+

    ,.8#("0?.(:";'.8 '9)($478 "09)." i (/9#$":* >.;' &&2C

    &9#) &&2AJ=K (r90 3*95 ;( 59*8#.G9 5.*9"*9 .0 "53$;*

    J=K 3*95 )(*; 8())(0$4 ;( 59*8#.G9 8'.$5#90 >.;';'#()G(84;(:90."+ G$((54A5."##'9" *405#()9 "05 #90"$ 5.*9"*9C

    .??9#95 G4 ;(F.0A)95.";95 905(;'9$."$ 5")"?9 "05 5.m3*9"87/"7(0 (1 8():$9)90; *4*;9)

    W**(8.";95 >.;' 90;9#('9)(##'"?.8 9C8($. >'.8' :#(5389* /9#(;(F.0c*'.?"A$.@9 ;(F.0fC `PQZDJZ i 8$"**.8 EJE6

    `PRUDJU A E3#(:9 XRPP `3;G#9"@ ^QX 8"*9* (1 J=K+ TX 59";'*

    d(;' "53$;* "05 8'.$5#90 "m98;95

    K;()"8' 8#"):*+ /().70?+ 5."##'9" cG$((54f+ $(> 19/9#

    'e:DSS>>>C858C?(/S98($.SXRPPS98($.(PRUS

  • 8/10/2019 coagulopathies and bleeding Disorder

    24/39

    @(='*3#& DJC

    W$*( " ).8#("0?.(:";'.8 '9)($478 "09)." >.;';'#()G(84;(:90."+ (#?"0 54*13087(0

    b90978 :#95.*:(*.7(0 ;( '4:9#"87/"7(0 (1

    8():$9)90; *4*;9)

    H"#9+ 59*8#.G95 )(#9 (r90 .0 8'.$5#90 L$"#9S:#9*90;"7(0 (1 5.*9"*9 >.;' 0(0*:98.N8

    .01987(0 :#(5#()9 (# *;#9**+ 0(; 0989**"#.$45."##'9"

    6(0*.59# 983$.I3)"G i "07 6Q )(0(8$(0"$ "07G(54i -";" i .05./.53"$ 8"*9 #9:(#;*

    \(##.*+ \"; H9/ \9:'#($+ XRPXY ^D[XX

  • 8/10/2019 coagulopathies and bleeding Disorder

    25/39

  • 8/10/2019 coagulopathies and bleeding Disorder

    26/39

    'e:DSS.C.)?3#C8()S/^,R/C]:?pZ[[R W889**95 [SXSXRPT

  • 8/10/2019 coagulopathies and bleeding Disorder

    27/39

    o(3 "#9 8"$$95 1(# 8(0*3$; (0 " Z^ 4( )"0 ;"@.0? >"#1"#.0 1(#";#."$ NG#.$$"7(0 >'( 8():$".095 (1 G#3.*.0?C J9 '"**'(#;09** (1 G#9";'C J9 '"* 0( 9:.*;"F.*+ '9)";9)9*.*+

    '9)";(8'9I."C JH lRt*+ 0(; '4:(;90*./9C &'9#9 "#9 8#"8@$9*(0 $30? 9F") "05 Xh :9#.:'9#"$ 959)"C J.* >"#1"#.0 >"*'9$5 1(# P 5"4C W5).**.(0 [C^Y '9)(?$(G.0 '"*598#9"*95 1#() PXCT "; G"*9$.09 ;( PPCl ?S5_C

    a"* .0.7"$ "::#("8' `!p

    a'"; *'(3$5 G9 5(09 0(>p

    Wf PR )?

  • 8/10/2019 coagulopathies and bleeding Disorder

    28/39

    E2+,) E2"L+. B,6#> 4./*3#7".,

    6(##98; .0"59g3";9 '9)(*;"*.* .0 G$995.0? :"790; E$9/";95 2&S.;' 1"8;(# 59N8.9084 c'9)(:'.$."f

    a'9#9/9# :(**.G$9+ "5).0.*;9#.0? *:98.N8 1"8;(# #9:$"89)90; *'(3$5G9 N#*; :#.(#.;4

    2#(:'4$"878 (# :#.(# ;( .0/"*./9 :#(8953#9 J.?' #.*@ (1 G$995.0? 8():$.8"7(0* G"*95 (0 :$"0095 *3#?9#4

    W\-

    6("?3$(:";'4 c'90 *9/9#9 8("?3$(:";'4

  • 8/10/2019 coagulopathies and bleeding Disorder

    29/39

    1",+ #./ 1*M3%&7+, N*() EEB

    u

    PR i PQ )$ S @? i #9*;(#9* 8("?3$"7(01"8;(#* ;( XRATRV 0(#)"$

    P 30.; (1 LL2 ;4:.8"$$4 XQR i TRR )$

    ,"0"?.0? /($3)9 .* .):(#;"0;

    "4 ;( 0(#)"$

    WG59$Aa"'"G+ "0*13*.(0+ XRR[+ U[DPXZlAPX^Q

  • 8/10/2019 coagulopathies and bleeding Disorder

    30/39

    4./*3#7"., #./ 1",*.$ 5"2 !2="'2+3*'*(#(+

    6(##987(0 (1 '4:(NG#.0(?909)." .0 8#.78"$$4 .$$

    :"790;* "; #.*@ 1(# '9)(##'"?9 ,"**./9 ;#"0*13*.(0

    6(0*3):7/9 8("?3$(:";'4 c-

  • 8/10/2019 coagulopathies and bleeding Disorder

    31/39

    1*,,+6*.#(+/ 4.(2#;#,3% !"#$%".

    \(0A$(8"$.I95 8$(v0? "87/"7(0 S ;'#()G(*.* 1($$(>95 G4*4*;9).8 NG#.0($4*.*C H9*3$; .* ;'#()G(84;(:09." "0559:$97(0 (1 8$(v0? 90I4)9* "05 NG#.0(?90C

    6"3*9*

    ,"**./9 7**39 .0]3#4

    M"*83$"# 905(;'9$."$ .0]3#4 K'(8@

    W)0.(78 w3.5 (# 1"; 9)G($.*)

    "3)"78 G#".0 .0]3#4

    ,"$.?0"084 K9/9#9 .01987(0

  • 8/10/2019 coagulopathies and bleeding Disorder

    32/39

    14! !&*.*3#& #./ F#9 E+#(%2+,

    -.*70?3.*'95 1#() &&2 c>'.8' "$*( '"**8'.*;(84;9*f G4 "G0(#)"$ 8("?*+ NG#.0(?90 "058$.0.8"$ *890"#.(

    6"0 '"/9 ;'#()G(*.* c"**(8.";95 >.;'

    )"$.?0"084f

    -

  • 8/10/2019 coagulopathies and bleeding Disorder

    33/39

  • 8/10/2019 coagulopathies and bleeding Disorder

    34/39

    !"%6#/*.> #''2"#3) (" ,%'2#()+2#'+%73 4O?

    \( 8$.0.8"$$4 *.?0.N8"0; G$995.0?

  • 8/10/2019 coagulopathies and bleeding Disorder

    35/39

    O";+& 82#& !"#$ E#3("2 4.)*9*("2,

    -.#98;$4 .0'.G.; ;'#()G.0 c5"G.?";#"0f+ (# "87/";951"8;(# x c#./"#(F.G"0+ ":.F"G"0f

    .;' 8("?3$"7(0 ;9*;*

    d$995.0? 8():$.8"7(0* 8"0 (883#

    ";)90; *3::(#7/9

    _.).;95 .01(#)"7(0 (0 3*9 (1 :#(;'#()G.0 8():$9F8(0890;#";9

    ,.9*G"8'+ &'#()G J"9)(*;+ XRPXY PR^D[XQ

  • 8/10/2019 coagulopathies and bleeding Disorder

    36/39

    P#,,*;+

  • 8/10/2019 coagulopathies and bleeding Disorder

    37/39

    ?+3"69*.#.( E#3("2 Q44#

    W::#(/95 .05.8"7(0 1(# ;#9";)90; (1 G$995.0?

    '9)(:'.$."8 :"790;* >.;' "07G(54 .0'.G.;(#* (11"8;(# M*D `m $"G9$ .05.8"7(0*D 0( G909N; 1(# )(#;"$.;4 "05

    .08#9"*95 #.*@ 1(# ;'#()(G(*.*

    o"0@+ XRPPY W00

  • 8/10/2019 coagulopathies and bleeding Disorder

    38/39

    ,(#;"$.;4 H.*@ -.m9#9089

    1(# (mA$"G9$ L"8;(# M

  • 8/10/2019 coagulopathies and bleeding Disorder

    39/39