Tutorial Module 4

“Scenario 2”
By : Group 5A

Tutor : dr. Arina F. Arifin

 GROUP 5A
1. Andi Zahra Shafanisa Oddang 110 2018 0008
2. Ammar Burhanuddin 110 2018 0025
3. Amar Ma’ruf 110 2018 0033
4. Naufal Ilmi Diennillah 110 2018 0038
5. Muh. Alief Harun 110 2018 0043
6. Andi Dwyndha Pratiwi 110 2018 0045
7. Azzahra Maghfirah 110 2018 0064
8. Musdalifah 110 2018 0070
9. Muh. Dwiki Darmawan 110 2018 0085
10. Muh Salman Naguib 110 2018 0097
 SCENARIO 2
A woman aged 40 years came to the
clinic with complaints of left leg swelling
experienced since one month ago, was
not initially clear but became more and
more increased swelling. Occur suddenly,
no pain and no fever. Sometimes itchy,
but stops himself without pengaobatan.
Patients also frequently complain of
headaches and tingling numbness in the
left leg. Already taking medication from
the clinic but they often recur. On
examination, the skin of the left leg is
black color. No palpable abdominal
mass in the left area. History of the
disease with the same complaint did not
previously exist. But patients often have
bruises before the menstrual period.
HARD WORD

NOTHING
 KEYWORDS

Female 40 years Headaches and tingling like

puncture of the left leg

Left foot swollen since one Physical examination: left leg

month ago skin color is more black

Initially it was unclear but No palpable abdominal

increasingly swollen mass in the left area

There is no previous medical

No pain and no fever
history

Sometimes the itching but quit on

Bruising ahead of menstruation
their own without treatment
 QUESTION
What it hemostasis and
the mechanism?
How does the mechanism
2
How management of the
disease in the scenario? 8 1 of the coagulation cascade?

9
Any examination for the Explain about vascular
7
Explain the
diagnosis? Islamic 3 disorders, platelets, and
perspective! freezing!

Explain the mechanism of

Explain the pathophysiology
of trombocytopenia? 6 5 4 symptoms in the scenario?

Organ what is involved?

DISCUSSION
 1. HEMOSTASIC

DEFINITION

Hemostasis is derived from the word haima (blood) and

stasis (stop), is a highly complex process, take place
continuously in preventing blood loss spontaneously, and to
stop bleeding due to damage to the blood vessel system.

MECHANISM

constriction of blood vessels → the formation of platelet

plugs → the formation of blood clots as ar esult of blood
clotting → finally occur fibrous tissue growth into the clot to
seal a hole in the vessel permanently.

Referensi : Adang Durachim.2018.bahan ajar teknologi laboratorium medic (TLM).Hemostasis.kementrian kesehatan republik Indonesia.
 2. COAGULATION CASCADE MECHANISM

Your Text Here

Referensi : Ibrahim, M. 2012. Jurnal : Hemostasis. FK Universitas Brawijaya

 3. VASCULAR DISORDERS, PLATELETS, AND
CLOTTING VASCULAR DISORDERS
Are a condition as a result of and disruption of blood flow,
both from, to and within the organ. Blood vessels are
important channels. Any reduction in blood flow will cause
eschemia in the tissue concerned. If ishchemia persist for a
long time there will be tissue death called infarction.

PLATELETS DISORDERS
Abnormalities of platelet number or function (or
both) can interfere with blood coagulation.
Platelets are too much or too little annoying
blood coagulation.

CLOTTING DISORDERS
Blood clotting disorders (also called thrombophilia or
hypercoagulable) is a disease of excessive blood
clotting - even in areas where freezing should not be
the case; such as in blood vessels - resulting in life-
threatening conditions.

Referensi : Kartini, A dan Kirana, DP. 2011. Gangguan penyumbatan dalam tubuh. Universitas Diponegoro. Semarang.
 4. MECHANISM OF SYMPTOMS

05
FOOT APPEAR
04 DARKER
03 MASS ON
ABDOMEN
02 HEADACHE &
PARASTHESIA
01 SWOLLEN
FOOT
BRUISE

Referensi : - Bimlesh C, Jyothi Y. 2016. “Thrombocytopenia and its causes”. Department of Pharmacology, Krupanidhi Collehe of Pharmacy Banglore
- Manoranjan M. 2009. Clinical Approach to Isolated Splenomegaly. - Dian, Fitra. 2015. Nyeri Kepala dan Anemia. FK Universitas Sumatera Utara
 5. ORGAN
BONE MARROW SPLEEN
INVOLVED

Referensi : Eroschenko, Victor P. 2009. Atlas Histologi DiFiore. Jakarta: Penerbit Kedokteran EGC
 6. PATHOPHYSIOLOGY
TROMBOCYTOPENIA

Referensi : Bimlesh C, Jyothi Y. 2016. “Thrombocytopenia and its causes”. Department of Pharmacology, Krupanidhi Collehe of Pharmacy Banglore
 LANJUTAN

Referensi : Bimlesh C, Jyothi Y. 2016. “Thrombocytopenia and its causes”. Department of Pharmacology, Krupanidhi Collehe of Pharmacy Banglore
7. ADDITIONAL EXAMINATION
Blood Smear

Bone marrow

Leucocyte Alkaline Phosphatase

(LAP)

LDH and uric acid increase Low levels of interlekin-6 and CRP

Pseudohyperkalemi
Prolongation of bleeding time
Normal or increased
thrombopoetin
Platelet Aggregation Abnormalities

Referensi : Adang Durachim.2018.bahan ajar teknologi laboratorium medic (TLM).Hemostasis.kementrian kesehatan republik Indonesia.
 8. MANAGEMENT OF DISEASE

Intravenous heparin as
anticoagulants

Comarin as anticoagulants

Preventing Blood Coagulation Outside

Body

Blood Coagulation Tests

Referensi : Setiati, Siti. 2015. Buku Ajar Ilmu Penyakit Dalam. Jilid II. Edisi VI. Jakarta: Interna Publishing
 9. ISLAMIC PERSPECTIVE

QS. AL-HADID : 22-23

)٢٢( ‫ّللا يَ ِسي ٌر‬ َ ‫ب ِم ْن قَ ْب ِل أ َ ْن نَب َْرأ َ َها ِإ َّن َذ ِل َك‬

ِ َّ ‫علَى‬ ٍ ‫ض َوال فِي أ َ ْنفُ ِس ُك ْم ِإال فِي ِكتَا‬ ِ ‫األر‬
ْ ‫صيبَ ٍة فِي‬ ِ ‫اب ِم ْن ُم‬َ ‫ص‬ َ َ‫ا أ‬
)٢٣( ‫ور‬ ٍ ‫ب ُك َّل ُم ْختَا ٍل فَ ُخ‬ َّ ‫علَى َما فَات َ ُك ْم َوال ت َ ْف َر ُحوا ِب َما آتَا ُك ْم َو‬
ُّ ‫ّللاُ ال يُ ِح‬ َ ‫س ْوا‬َ ْ ‫ِل َكيْال تَأ‬
Meaning :
22. Every calamity befalls on the earth and that happened to yourself, everything has been written in the Book (Lawh
Mahfuz) before We make it happen. Really, so it is easy for Allah.
23. So that you do not grieve for what escapes you, nor too elated by what he has given to you. And Allah does not
like anyone who is arrogant and pride.

Referensi : Al-Qur’anul Karim. QS. Al-Hadid (57) : 22-23

THANK
YOU