Manifestasi Klinis

Site of bleeding

Petechiae

Ecchymoses (bruises)

Hemarthrosis / muscle bleeding

Bleeding after cuts & scratches

Bleeding after surgery or trauma

Platelet disorders

Skin muscous membranes (epistaxis, gum, vaginal, GI tract)

Yes

Small, superficial

Extremely rare

Yes

Immediate, usually mild

Coagulation factor

disordersDeep in soft tissues (joints,

muscles)

No

Large, deep

Common

No

Delayed (1-2 days), often severe

Vascular

Perdarahan vascular , Petechie, Purpura

Aging process senile purpura (Bateman’s

disease)

Infectious Meningococcus Rocky

Mountain’s syndrome typhoid fever

Roseola spot

Immunologic Henoch-Schonlein purpura

↑ fragility capillary infectious, vasculitis

Senile Purpura

Henoch-Schonlein purpura

20y Male, fever, painful symmetric polyarthritis for a day. During the next two days, edema and palpable purpura developed.

Platelet Disorders - Features:

Mucocutaneous bleeding

Petechiae, Purpura, Ecchymosis.

Spontaneous bleeding after trauma

CNS bleeding

Prolonged bleeding time (BT)

Dengue Hemorrhagic fever

Platelet deficiency..

Petechiae

Do not blanch with pressure (cf. angiomas)

Not palpable (cf. vasculitis)

(typical of platelet disorders)

Coagulation disorders:

Deficiencies of Clotting factors

Onset - delayed after trauma

Deep bleeding • Into joints - Hemarthroses • Into deep tissues – Hematoma • large skin bleed – Ecchymoses

Ecchymoses

(typical of coagulation factor disorders)

Platelet Coagulation

Petechiae, Purpura Hematoma, Joint bl.

Summary

Symptom Platelet Coagulation Petechiae Yes No

Sites Skin & Mucosa

Deep Tissue

Time Immediate Delayed

Ecchymoses/Hematomas

Yes Yes

PEMERIKSAAN PENUNJANG UNTUK PENDEKATAN DIAGNOSIS KELAINAN

HEMOSTASIS

PEMERIKSAAN PENYARING SISTEM KOAGULASI

GLOBAL TEST

FBC

BT

TORNIQUET TEST

PT

APTT

D-Dimer

CELL COUNTER TORNIQUET TEST

BLEEDING TIME

Put blood pressure at 40 mmHg First blood drop is wipedNext, blood is tipped off by filter paper every 30 sec

Normal is less than 5 min

D-dimer test by ICT technique (qualitative)

D-dimer by chomogenic assay (quantitative) in ng/ml