modul 2 bleeding a4

8/20/2019 Modul 2 Bleeding a4

1/20

BLEEDING

PBL GROUP A4

PRESENTS


2/20

CASE STUDY

A five years old girl was brought to the

hospital because there were red spots on

her arms , lower extrimities and her body.

She also had anal bleeding but no fever .

6 days prior to this , this child had just

recovered from cold.


3/20

KEYWORDS

• 5 years old male toddler

• Red spots in arms, legs and body

• Anal bleeding• No e!er

• Re"o!ered rom "o#g$ and "old %

days ago


4/20

IMPORTANT QUESTIONS

& What are the diferential diagnoi!

& What "a#e anal $leeding!

& Bleeding %atho%h&iolog&!& 'ae(otai (e"hani(e!

& What i the "onne"tion $et)een the

$leeding and the "o#gh and "old!& 'o) did the red %ot o""#r!


5/20

D'((ERENT'A)D'A*NOS'S

• D'SSE+'NATED 'NTRAASCU)ARCOA*U)AT'ON

• 'D'O-AT.'C T.RO+/OCYTO-EN'C-UR-URA

• .AE+O-.')'A

• ON W'))E/RAND (ACTOR D'SEASE

• .ENOC. SC.O)E'N SYNDRO+E

• ACUTE )EUKAE+'AS


6/20

• DIC

0 is a "omple1 syndrome 2$i"$"ompli"ates many serio#s ilnesses"a#ses bot$ $aemorr$age andt$rombosis3

• ITP

0 is a disease "$ara"teri4ed byimm#nologi"al destr#"tion o platelet3

• HAEMOPHILIA

- is an in$erited disorder o "oag#lation"a#sed by "oag#lating a"tor die"ien"y


7/20

• V! "#S$AS$

- t$e most "ommon in$erited

bleeding disorder "a#sed bym#tations in t$e gene or W(3

• %$&'(% S(%')$#& S*&"+'$

- a systemi" syndrome in!ol!ingsin, *'T 6oints and idneys3 't is"a#sed by !as"#lar anomalies3


8/20

• A(-$ )$-/A$#AS

0 A "lini"al maniestation o iron

de7"ien"y2$i"$ a8e"ts t$e rate o

eryt$ropoiesis

and "a#sing anaemia3


9/20

"#( #0 haem V! %SS Ac)

5yrs old ♀ 1 2 1 2 1 2 1 2 1 2 1 2

Red spots 1 1 1 1 1 1

Anal leed!n" 1 1 1 1 1 1

#o $e%er 2 1 2 2 2 1

Cold n &o'"( 2 1 1 2 2 1

*OMPARISON TABLE


10/20

#"#'0A%#( %+'3'(*'0$(

0-+0-+A

• A disease C$ara"teri4ed byimm#nologi"al destr#"tion oplatelets3

• Di!ided into a"#te and "$roni"3

• A"#te orm #s#ally seen in"$ild$ood, "$roni" #s#ally inyo#ng 2omen3


11/20

• AETIOLOG)

0 idiopat$i"• PATHOGE#E*I*

-ACUTE

liely post !iral "ases 'g* antibodyatta"$es to !iral antigen absorbedonto t$e platelet s#ra"e3

0 C.RON'C

A#to antibodies against plateletmembrane3 -latelets sensitised2it$ a#toantibodies destroyed inspleen and li!er3


12/20

• ()#(A) !$A-+$S

0 p#rp#ri" ras$

0 "on6#"ti!al $aemorr$age

0 menorr$agia

0 prone to bleed rom m#"o#smembrane


13/20

• #&V$S#4A#'&S

0 blood "o#nt and 7lm

0 platelet "o#nt3

0 in"reased bleeding time0 -T and a-TT normal

0 t#rniett test 9:;


14/20

• A&A4$$&

+ prednisolone0 spleene"tomy

0 intermittent imm#noglob#lin

0 "y"lop$osp$amide0 dana4ol

0intereron


15/20

D'C

C$ara"teri4ed by intra!as"#lardeposition o 7brin anda""elerated degradation o 7brin

and 7brinogen "a#sed by a"ti!ityo proteases3


16/20

• A$#')'4*

+ in,e"tion -%arti"#larl& e%ti"ae(ia

+ (alignan"&

+ o$tetri" e(ergen"&

+ ho".

+ e/ere hae(ol&ti" tran,#ionrea"tion

+ li/er dieae


17/20

TR'**ER

T'SSUE (ACTORRE)EASE

CYTOK'NERE)EASE

-)AS+'NO*ENACT'ATOR RE)EASE

T(ro+!n

"enerat!o

n

Platelet

a&t!%at!o

n

t(ro+os!s

$!r!n

T!ss'e

ne&ros!s

leed!n"

$!r!nolys!s

Plas+!n "enerat!on

t(ro+o&ytopen!a


18/20

• #&V$S#4A#'&

0 red#"ed platelet "o#nt0 -T and a-TT prolonged

0 t$rombin time prolonged

0 7brinogen le!el red#"ed0 $ig$ (D-

A&A4$$&

+ treat(ent o, #nderl&ingdieae

+ 00P and "r&o%re"i%itatead(in


19/20

CONC)US'ON

• (rom t$is "ase st#dy, 2e

0 !ario#s types o bleeding disorders

0 #nderlying "a#ses o t$e disorders

0 in!estigations in bleeeding disorders

0 t$e managements and prognosis o

bleeding disorder patients


20/20

T.ANK YOU

modul 2 bleeding a4

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