Presentation B4

Bleeding

Scenario
Children 5 years old, comes to hospital because her have peteckie in the arms, legs, and body and blood come out from anus and than not have a fever. 6 days ago she has recover cough and have a cold.

Key Words
Children 5 years old Peteckie in the Arms, Tungkai and Body = fever Common Cold Bleeding out from anus

Question
What is the patomekanism of hemolisis? What is the patomekanisme of Gejala ? What is the diagnosis ? What is the medical ?

DIC
Definition
Disseminated Intravascular Coagulation is a clinical syndrome is

characterized by the widespread activation of coagulation, which

results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessels.

Etiology
Sepsis Trauma Cancer Obstetrical complication Vascular disorders Reactions to toxins

Clinical Symptoms
Petechie, echymosis, and hematoma in the skin Hematuric Melena Epistachsis Massive bleeding in the pulmonal, brain and intraventikular. Local ischemic and necrosis.

Pallor, hipotensi and tachicardi.

Acral cyanocis

PATHOMECANISM
Trigger Systemic inflamatory response Cytokines Activation of tissue factor and factor VII

Increased generation of thrombin The simultaneous suppression mechanism Delayed removal of fibrin Systemic coagulation Intravascular deposition of fibrin Thrombosit of small and midsize vessels Organ failure

of

physiology

anticoagulation

Depletion of platelets and coagulation factor Bleeding

Laboratory
Hypofibrinogenemia Trombocytopenic

Prolongation of clotting times, such as thrombin time,

prothrombin time and the activated partial-thromboplastin time.

The presence of FDP D-dimer test. Low plasme of coagulation inhibitors such as antithrombin III Examination of a blood film red cell fragmentation (schistocytes)

Liver and renal function tests

Management
Treatment of the underlying disorder. Anticoagulation heparin, with dose 15 u/kg/hour by continuous infusion. Platelet concentrate and palsma. Concentrate of coagulation inhibitor antithrombin or protein C. Concentrate of blood component fresh frozen plasma or cryoprecipitate Plasmin inhibitors Tranexamic acid or aprotonin Vit. K and folic acid Gabexate Mesylate a synthetic inhibitor of serine protease (including, thrombin and plasmin)

ITP
(idiophatic Trombositopeni Purpura)
Definition

Merupakan kelainan autoimun dimana autoantibody dibentuk untuk mengikat trombosit.

Clinic Manifestation
bleeding petecki, ekimosis, melena, hematuri. Appliance blood in wheightTrombositopeni Torniquet test positif

Gambaran darah
- Trombositopeni - Perifer blood smear shape of trombosit abnormal, big size. - Bleeding of time prolonged - PT and APTT normal

Patomechanisme
ISPA celular defence humoral defence cardage IgG to virus/bakteri IgG patch to Trombosit

TROMBOSITOPENI

Penatalaksanaan
- Can recover by self at children - Kortikosteroid - Imunosupresif like vinkristin, infus vinblastin, azatiopirin and silofosfamid. - splenoktomi represent the definitive therapy to adult patient ITP.

Thank U

Thank U
Thank U

Thank U

Thank U
B4