by du Dita

. Sp PD
_ .
-
KHON

ITP
< 100.000)
→
Trombositopenla mene
tap / AT periter
ambat antibody yangmernsdk Trombosltseoara
tang sung dan Mega Karlosit ,
3) Fagositoslsdlltmpha
dan
Mbngganggn antes is trdmbopoletlh
→ 37 reslko Perdanahah
-

Algorithm ITP
→ Eti 1091 :

Primary 100%) Idiopathic :

-
seunhder Acquired APS:-
:
-

-
SIE
-
HCV
Drug Induced :
-

Heparin NSAIDs, .
Rifampicin
penicillin
-

Apiary
HIV
MMR Varicella
-

Vaccine :
.

limpho proliferative
-

disorder
→
Insiders , :
-

Wanita >> 1am

-

Usia 20-30 doin 7765th → Jordi Kramm

-

Spontaneous : →
Pada Anan 78% Aunt
dan self limiting
→ Fast :
Newly DX Persistent XP Chronic ITP

3. bulan → 3- Harlan → > thbulan

Pathophysiology
→ loss of tolerance Auto antibody
Antiplatelet Clmuno globulin)
91%0 protein GPIIB /IIIa
atau
GPIB /II
Pada platelet
↓
realist Antigen -

Antibody
↓
dlkenali
Macrophage> Fagosltosls
&ˢd dendritic &APC_
cpql.tk/per1sh.gMHC
→

]
↓
reins#
aatoreatltlltog
set plasma ↓
Auto Antibody dllerenslasl dlttlvasl
←
Platelets>
E
SEID
ugdsel plasma y
AKTIVGSI
7)
destruct ←
CD8CTc )
Trumbosit 195 ↓
ganggu ⇐ APOPHIS Meyering
C-
maturity megauarioslt
-

Presents blinis : -

Bleeding -

Fatigue
-

Purpura
→
Diastase Normal
At Hb .
,

a-
Kalanga normal Pltkrkan ,

kemung winan 1am leukemia /MDS / :

Dk

→
Diag nos a ITP =
Diagnosis EUSUIUSI dart Tnombosltopenia
↳
Tidau a- da test Yang spent in
↳ D- ✗ : obat Herbal Tonic Water Interest sebeluga
, . ,

PF : liver disease Bleeding manifest lymph nodes

, , .

Organo megaly
lab : -

CBC MDT 1Mt . dumping , morph)

-
HCV.HN isolated
- Kalan add Kela Man Selam trombone Pena
: • AND Kalan cdriga Connective tissue
disease
•
H .

Along
•
Thyroid Ft test ITPO
kecamatan
- BMP tcdaiepeplu Kemal, ada lath
 BMP
tldakdivenomendaslkankec.ua/I:-adagejalaslStemlk
→

-
Tanda abnormal
Gagallerapl Medal
-

ada Sltopenia lain

-

Kecunigaan Iain Pada MDT

Isolated tromboneopen a dgn BM Failure
-

-
Usia > 60th → ↑ kecurigaan
syndrome
MDS

→ Direct Platelet Auto Ab "

/ MII bureau rule out
↳ sensitives 83%
spesltisitas 92%
.
 Guideline ASH

Management Itp
20192
-

At
f-
> sorb < sorted
Asimptom → Mondial :O > 65
Asimptomp OAC
/minor bleeding / minor bleeding -

Komorbld
↓
-

↓
observant corticosteroid

Newly d✗ AT < orb Asymptom randp

/
:
,
→
,

µ, /minor
bleeding
✗ Persistent dt

Plt ≥2orb
: it → rasdl

,
Asymptom → rasdl
/minor
bleeding
lwewly Dx)
•
NB : -
Ada Uecumqaandxlain , komorobid significant ,

resluoperdardhan
First-line
-

: -
Prednisone : 0,5 -2mg /Ug 1ham
↳
Gnnmggncsudah
< term asun

tapp down)
-

Dexamethasone : 40mg / Kg 4ham

tanpa tapp down
dipevluuan AT
→ Hua respon lebihcepat ,

Albert uan Dera iuarena resspon 7ham

terqpl Misia .

→ Observable HT ,
tipergkuemia , Yangyuan tidier .

gangguan mood , intact gaster,

glaucoma hyopatl Osteoporosis
,

↳ Perla obs HRQOL

lbepresl / Ahmetas
-
IVIE = -

lgr / kg / hari 1- 2ham Crespin rate 05%)

→

AT 1-2ham tape
Katan
( Us Korntra) Penny Katan Maus 3-4ngg
-

ESO metro torc

:
Indicus
Kl / ≠
→
blasanya detention Mau
Oprespond
'gn Ks
-
Anti D - : Eso : Hemolysis

* ME 1- KS : sika
butuurespoulehihcepat
 Seconding biasauya padaretrauter
-
:

→
Splenectomy :
"
/↓ Destrause Plt & ↓ Produces,
Auto Abplt
-

Response rear 00%1 68% remix . 33% relaps

-

Sebelum op : -
Vaccine :
-

Pneumococcus
-
H Influenza
.

meningococcal
MM 2min
.

yguctlauusrhgd
-

Optima hsasi AT 1042mgg)

Tun da sd 12 bulan /
"
potenslal
-
rents 1
dan << Eden Sam
ping

→
Rituximab : 3751mF
9mmyguivds.am Per →
minygu

→ TPO RA -
: 80 -78mg 1ham → Beker>a Pada
Progenitor Megdkariosie
(Eltvombopag ) → Etna, , poky
→ At them ball Turun RMMgyu dl Stop

→ Romi plostim :
lmcg hey /Sc → It / mingyu
- Pemillhan trap , second line

-
Treatment Goal : _ Individualized treatment
decision
-

cegah perdanahan
-
men
gaga AT> 30ms
cegah Toastsites tetapl
-

Optimal is as , HRQOL
 International Guideline

third line

target Atul
tndaudh :
 Anemia Aplastic by :

dnkartiua.sp.PK
→ BM tidaumampa memproduces, Krona

komponen ddnah →
Pdnsltopenia
→
Berhubungan dangan produksl HLA -

DRE
→ KIM is:
Interest
_

}→
-
Perdardhan Anemia Trounbosltopeuia
,

Antonis
banking trans Just
-

→
Fanque
-

berulaug
→ Inside use : -

Sarang
-

Peau :
Usta Muda / 760th

→ Eteologl : -
Direct Damage = • Sitotousl U
•
radical
•
Benzene

-
Immune Destruction : •
Thymoma
④ •
seronegative
* Hepatitis
•
Eosinophilic
Fasciitis
-
Genetic Defect : • Telomere disease
• Anemia Fanconi
•
Germline mutation
 Constitutional Bone Marrow Failure

Is
↳ set tsitotousik → Auto Antibody 3)
Marrow
tissue
rsurroundlng

-
Patolneuauis we Ctcddu haya I Fautor Predisposes 1)
( Hamper sauna dqn Itp ) → CAO Taek
↓
expand
↓ regulatory
1-NFL 3)
☒ 1-cell
Inactive
•

•
INF J D
'

Fas ligand 7)
↓
BM ← destructs stem cell
failure
-
Multifaceted Pato physiology

☐
searing dipimpai pada AA
> Higher risk progression to MDs / AML

¥#-_f
Mutated Gene Prog
In Acquired AA

* 1st :
Immunosuppressive Therapy
 Immune escape & Clonal evolution
"
ᵈF¥¥¥¥a

Proffered #

☐
1*-7 bebarapa donal
→
aran
tsd
duende

penctsauah Set ?
normal

↓
cloud
makgua
✓ Rauscoopeuia

Disease overlapped
4 AA
-
Cara rdembedauan AA dcfn MDS

I
O

I
trifocals u

Beirut Ercorositldnh
Jml Sedat Bdydk
-

klasifiuasi AA
Teran
i
-
Non severe : -

Immunosuppressive th
AA -
ATE / CSA
-
CSA
-
Dadizumab
Severe : BM Transplantation ( BME)
- -

Alt -
Allogeneic Brat % HLA matched
-

sibling donor
-
Alternative donor BMT

Tanuki

Non Candidate : -
Immuno
Suppes we
[ Hcgh dose
cyclophosphamide
Adult AA Algorithm

Ii
↳ BMP [ Apakah transformasi
ada

Malign MDS/AML))
a