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RUDY AFRIANT
SUB DIVISI HEMATOLOGI & ONKOLOGI MEDIK
BAGIAN ILMU PENYAKIT DALAM
FAKULTAS KEDOKTERAN UNIVERSITAS ANDALAS
NOVEMBER 2017
BLEEDING
COAGULATION
VASCULAR
PLATELETS
1. The primary haemostatic system
Primary haemostasis
Platelet aggregation
trombosit
Adhesion
endothelial cells
Activation
sub endothelial tissue
Vascular Aggregation
injury
White clot
Formation of
: platelet plug
exposed sub
endothelial tissue
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Bleeding Disorder caused by Platelet
VWD Glanzmann
Thrombasthenia
Thrombositopenia
Differential Diagnosis
Pseudothrombocytopenia
Decreased Production
Increased Destruction
Sequestration
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2. Secondary haemostasis
Coagulation cascade
leads to clot formation
Clot
growth
Fibrin threads
7
APTT PT
Hypocoagulability:
- Bleeding diathesis caused by coagulopathy
- Excessive bleeding and a lack of clotting
Acquired Genetics/ Hereditary
Medications:
• Anticoagulation: warfarin, UFH, LMWH, Frequent cases
fondaparinux
• Thromboslytics: streptokinase, urokinase. • Hemophilia A, B
tPA (alteplase, reteplase, tenecteplase)
• Antiplatelet agents: aspirin, clopidogrel • Von Willebrand disease
Diseases:
• Liver failure
Rare cases
• Vitamin K deficiency • Bernard-Soulier syndrome
• Disseminated intravascular coagulation (DIC)
• Haemotoxic venom from certain species • Glanzmann's
of snakes
• Dengue hemorrhagic fever (DHF), Dengue
thrombasthenia
Shock Syndrome (DSS)
• Leukemias
Autoimmune: inhibitors to coaugulations (F VIII
inhibitor), Antiphospholipid syndrome (APS)
Other terms of DIC
• Overt DIC = decompensated DIC:
- a state in which the vascular endothelium and its components have
lost the ability to compensate and restore homeostasis in response to
injury
- the result is a progressively decompensating state that is manifest
as thrombotic multiorgan dysfunction and / or bleeding
• Clinical manifestations
• Laboratory diagnosis
• Imaging diagnosis : CT scan
Clinical symptoms Disorders
•Wiskott-Aldrich syndrome, where they
may resemble a few bruises
Petechiae (red spots) •Acute leukemia
•Chronic leukemia
•Vitamin K deficiency
•Acute leukemia
Purpura and ecchymoses •Chronic leukemia
•Vitamin K deficiency
•Wiskott-Aldrich syndrome
Bleeding gingiva(gums) •Acute leukemia
•Chronic leukemia
Blood loss (ml) to 750 750 – 15000 1500 – 2000 > 2000
Pulse rate (minute) < 100 >100 > 120 > 140
Disseminated
intravascular Prolonged Prolonged Prolonged Decreased
coagulation (DIC)
Prolonged or
Von Willebrand disease Unaffected Prolonged Unaffected
unaffected
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