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- 1. PLATELET DISORDERS PLATELET DISORDERS ARE CLASSIFIED AS QUANTITATIVE OR QUALITATIVE
- 2. QUANTATIVE PLATELET DISORDERS THROMBOCYTOPENIA IT IS DEFINED AS A PLATELET COUNT BELOW 150X10*9/L THROMBOCYTOSIS PLATELET COUNT IS ELEVATED ABOVE THE NORMAL ACCEPTABLE REFERENCE RANGE
- 3. THROMBOCYTOPENIA A COUNT BELOW 100,000/ Ûl is generally considered to constitute thrombocytopenia SPONTANEOUS BLEEDING does not become evident until the count falls below 20,000/ul PLATELET COUNTS in the range of 20,000 to 50,000/ul can aggravate post-traumatic bleeding
- 4. CLASSIFICATION OF THROMBOCYTOPENIA DECREASED PRODUCTION OF PLATELETS DECREASED PLATELET SURVIVAL SEQUESTRATION DILUTIONAL
- 5. CLASSIFICATION OF THROMBOCYTOPENIA (DECREASED PLATELET SURVIVAL) IMMUNE AUTOIMMUNE: IDIOPATHIC THROMBOCYTOPENIA PURPURA SLE ISOIMMUNE: POST TRANSFUSION AND NEONATAL DRUG –ASSOCIATED: QINIDINE,HEPARIN,SULFA COMPOUNDS INFECTIONS: INFECTIOUS MONONUCLEOSIS,HIV INFECTIONS,CYTOMEGALOVIRUS
- 6. CLASSIFICATION OF THROMBOCYTOPENIA (DECREASED PLATELET SURVIVAL) NONIMMUNE DIC THROMBOTIC THROMBOCYTOPENIC PURPURA GIANT HEMANGIOMAS MICROANGIOPATHIC HEMOLYTIC ANEMIAS
- 7. IDIOPATHIC THROMBOCYTOPENIA PURPURA (ITP) PRIMARY OR IDIOPATHIC ITP ACUTE ITP CHRONIC ITP SECONDARY ITP
- 8. CHRONIC ITP DEFECTIVE HEMOSTASIS DEFICIENT PLATELET PRODUCTION THROMBOCYTOPENIA PLATELET SENSITIZATION PLT SEQUESTRATION / DESTRUCTION COMPENSATORY ACCELERATION OF PLT PRODUCTION ANTIBODY ANTIGEN-ANTIBODY COMPLEXES MEGAKARYOCYTE INJURY IMPAIRMENT OF PLATELET FUNCTION
- 9. PATHOGENESIS CHRONIC ITP IS CAUSED BY THE FORMATION OF AUTOANTIBODIES AGAINST PLATELET MEMBRANE GLYCOPROTEINS,IIb-IIIa OR Ib-IX THE ANTIPLATELET ANTIBODIES ARE OF IgG CLASS OPSONIZED PLATELETS ARE RENDERED SUSCEPTIBLE TO PHAGOCYTOSIS BY THE CELLS OF MONONUCLEAR SYSTEM SPLEEN IS THE MAJOR SITE OFREMOVAL OF SENSITIZED PLATELETS MEGAKARYOCYTES MAY BE DAMAGED BY AUTOATIBODIES LEADING TO IMPAIRMENT OF PLATELET PRODUCTION
- 10. MORPHOLOGY SPLEEN NORMAL IN SIZE CONGESTION OF SINUSOIDS FORMATION OF PROMINENT GERMINAL CENTERS SCATTERED MEGAKARYOCYTES WITHIN SINUSES BONEMARROW INCREASED MEGAKARYOCYTES (IMMATURE WITH LARGE NONLOBULATED SINGLE NUCLEI) SECONDARY CHANGES RELATE TO HEMORRAGES
- 11. COMPARITIVE FEATURES OF ACUTE AND CHRONIC ITP AGE CHILDREN 2-6 YEARS PLT <20X10*9 / L ONSET ABRUPT ( BLEEDING) ANTECEDENT 1-3 WEEKS INFECTION SEX NONE SPONTANEOUS 80% REMISSION THERAPY NONE,CORTICOSTEROIDS AGE ADULT 20-40 YEARS PLT 30-80X10*9 / L ONSET INSIDIOUS ( BLEEDING) ANTECEDENT UNUSUAL INFECTION SEX F:M 3:1 SPONTANEOUS UNCOMMON REMISSION THERAPY CORTICOSTEROIDS,SPLENECTOMY
- 12. CLINICAL FEATURES CHARACTERIZED BY BLEEDING ITO SKIN AND MUCOSAL SURFACES PETECHIAE,ECCHYMOSES H/O EASY BRUISING,NOSE BLEEDS,BLEEDING FROM GUMS,AND HEMORRAGES INTO SOFT TISSUES FROM RELATIVELY MINOR TRAUMA THE DISEASE MAY MENIFEST FIRST WITH MELENA,HEMATURIA,OR EXCESSIVE MENSTRUAL FLOW SUBARACHNOID HEMORRAGE AND INTRACEREBRAL HEMORRAGE ARE SERIOUS RARE CONSEQUENCES SPLENOMEGALY AND LYMPHADENOPATHY ARE UNCOMMON IN PRIMARY ITP,AND THEIR PRESENCE SHOULD LEAD ONE TO CONSIDER OTHER POSSIBLE DIAGNOSES
- 13. DIAGNOSIS THE DIAGNOSIS IS MADE BY THE EXCLUSION OFALL OTHER CAUSES OF THROMBOCYTOPENIA LABORATORY TESTS SHOULD INCLUDE PERIPHERALBLOOD COUNT EXAMINATION OF BLOOD SMEAR TESTS TO RULE OUT OTHER CAUSES BONE MARROW EXAMINATION LOW PLATELET COUNT THEIMPORTANCE OF BONEMARROW EXAMINATION IS TO RULE OUT THROMBOCYTOPENIAS RESULTING FROM BONE MARROW FAILURE.A DECREASE IN THE NUMBER OF MEGAKARYOCYTES ARGUES AGAINST THE DIAGNOSIS OF ITP ABNORMAL LARGE PLATELETS BLEEDING TIME PROLONGED PT NORMAL APTT NORMAL TESTS FOR PLATELET AUTOANTIBODIES ARE NOT WIDELY AVAILABLE