SINDROMUL HEMORAGIPAR

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HEMORAGIA

Text of SINDROMUL HEMORAGIPAR

  • SINDROMUL HEMORAGIPAR

  • CLASIFICAREA SINDROMULUI HEMORAGIPAR (SH) I. Vasopatii II. Trombocitare:- trombocitopenii - trombopatii III. Coagulopatii

  • SH Tabloul Clinic 1. Hemoragii pe mucoase 2. Cutanate 3. Subcutanate 4. Musculare 5. Articulare 6. Viscerale 7. SNC

    -Izolate sau asociate.

  • SH Tabloul Clinic Alte simptome:

    - Febr - Paloare - Tahicardie - Adenopatii - Hepatomegalie - Splenomegalie - Spleno - hepatomegalie

  • SH Diagnostic diferenial

    - Urticaria hemoragic - Alergii cutanate - Boli infecto-contagioase cu exantem - Artrite - Etc.

  • DIATEZ HEMORAGIC

    Normal Timp de coagulare Prelungit

    COAGULOPATII

    BOALA VON WILLEBRAND

    Normal Timp de sngerare Prelungit

    PURPUR VASCULAR

    PURPUR SCHONLEIN HENOCH

    Numr trombocite

    Normal Sczut

    TROMBOCITOPENII

    ANOMALII CALITATIVE TROMBOCITARE

    (genetice sau dobndite)

    BLEEDING DIATHESIS

    Normal Coagulation time Prolonged

    COAGULOPATHIES

    Normal Bleeding time Prelungit

    VASCULAR PURPURA

    SCHONLEIN HENOCH PURPURA

    Platelet count

    Normal Low

    VON WILLEBRAND DISEASE TROMBOCYTOPENIA

    TROMBOPATHIES

    (genetic or acquired)

  • Sindromul hemoragipar. Explorare I. Timpul vasculo - plachetar (VN) TS = 2 4 min. Trombocite = peste 150.000/mm3 Test garou (Rumpel Leed) sub 10 peteii

    II. Coagularea propriuzis TC = 8 - 10 min TH = 1 min 20sec. - 2 min. 40 sec. TQ = 13 14 sec (100%) APTT = 35 45 sec.

  • Sindromul hemoragipar. Explorare

    Vasopatii singura anomalie TS uor prelungit doar la 1/3 din cazuri.

  • Sindromul hemoragipar. Explorare

    SH trombocitare : - trombocitopenii - tr sub 150.000/mm3 - TS -

    - trombopatii: - nr. Tr= N - TS - - teste func. Tr. modificate

  • Sindromul hemoragipar. ExplorareCoagulopatii: TS - N Tr N

    TH N + TQ - deficit calea extrinsec

    TH + TQ-N + APTT - deficit calea intrinsec

  • Sindroame hemoragice trombocitareClasificare Trombopatii - genetice - dobndite Trombocitopenii : 1.Distrucie - imun: - PTI -S.Evans -medicamente -LES - neimun :CID, inf. virale,etc 2.Distribuie: hipersplenism 3. Scderea produciei

  • Purpura trombocitopenic imun (PTI)Etiopatogenez:

    CIC (virus + ac. antivirali) alipite de TR macrofag din splin fagocitare;

    Ac. anti-Tr - Tr macrofag splenic fagocitare.

  • Purpura trombocitopenic imun (PTI)Tabloul clinic - Starea general bun , afebril - Infecie viral cu 1-4 sptmni anterior; - Peteii - Echimoze - Epistaxis - Gingivoragii, bule hemoragice - Anemie - Absena adeno hepato splenomegaliei !!!

  • Purpura trombocitopenic imun (PTI) Examinri de laborator

    TS prelungit ( 6 60 min.)

    Trombocite : < 20.00/mm3 F. Sever 20.00 60.000/mm3 - F. Medie 60.00 100.000/mm3 - F.Uoar

    Puncie medular :megacariocite netrombocitogene Dg. diferenial LAL.

  • Purpura trombocitopenic imun (PTI)Evoluie

    Acut pn la 6 luni Recidivant Cronic - peste 6 luni.

  • Purpura trombocitopenic imun (PTI)TratamentSub 20.000/mm3 Tr (40.000) F. severe : IgG 400mg./Kg /zi 5 zile Methilprednisolon 30 mg/kg/zi- 3 zile.

    F. medii/uoare:Prednison: 1 2 mg/Kg/zi 3 subdoze 10 14 zile apoi reducerea dozei- sistare.Transfuzie: MTr, ME

  • Purpura trombocitopenic imun (PTI)Tratament

    Spenectomia: - F. Cronic - vaccin anti - pneumococ - hemophilus - meningococ

    Pentru intervenii chirurgicale- minim 50.000 Tr/mm3 Contraindicaii: aspirina, injecii im, vaccinri 1 an.

  • Purpura trombocitopenic imun (PTI)

    Prognostic: vindecare - 3 luni 75% - 9 12 luni 90% cronicizare 10 %.

  • Boala hemoragic a nou-nscutuluiEtiologie :Vit. K ( rezervor, flora din colon) VIT. K sinteza fact.: II, VII, IX, X, Prot. S, C.

    Clinic: Hemoragii - Melen: unic sau multipl - Hematoame sc - Hemoragii din bontul ombilical - H. vaginal - Hematurie - Hemoragie cerebral

  • Boala hemoragic a nou-nscutului Forme clinice :

    - precoce - clasic: 2- 3 zi - tardiv: 1 -3 luni.

  • Boala hemoragic a nou-nscutuluiTratament 1. Profilactic: vit. K 1mg- im, iv;

    2. Curativ: K1, K3 1 2 mg, maxim 5 mg. im, iv Plasm : 1o ml/kg la 12 ore.

  • Coagulopatii Hemofilia AGenetic:- - boal gonozomal recesiv - F VIII C - Xq 28 - femeile purttoare - brbaii - bolnavi

  • Coagulopatii Hemofilia A Clinic: - Hemartroz - Hematoame cutanate - Epistaxis - Gingivoragii - Hematurie - Musculare : psoas - Zone periculoase: orbitar, faringe, etc. - SNC

  • Coagulopatii Hemofilia AF VIII C valoare normal = 50 150% Forme clinice : Sever: F VIII C sub 1 % Medie: 1 5 % Uoar: 5 25 %

  • Coagulopatii Hemofilia AExaminri de laborator: TC prelungit