文档介绍：血小板低下症的区分及血小板输注合理(hélǐ)评估
张志升 台湾台大医院输血(shūxuè)医学科
2022/6/26
第一页,共六十页。
Content
血小板低下症的原因(yuányīn)
新生儿血小板低下症
药物诱导血小板低下血小板低下症的区分及血小板输注合理(hélǐ)评估
张志升 台湾台大医院输血(shūxuè)医学科
2022/6/26
第一页,共六十页。
Content
血小板低下症的原因(yuányīn)
新生儿血小板低下症
药物诱导血小板低下症
血栓性血小板低下症
特发性血小板减少紫癜
肝素诱导血小板低下症
第二页,共六十页。
血小板低下(dīxià)症的原因
骨髓制造血小板的功能减少
血小板制造可因放射线、化学治疗或病毒感染等原因受抑制,而骨髓本身(běnshēn)疾病,如再生不良性贫血、白血病,骨髓分化不良等皆可引起制造减少。
血小板在周边血液被破坏增加
常见的有经由产生自体免疫抗体来破坏,如全身性红斑性狼疮、特发性血小板减少性紫斑症、某些药物等,而病毒感染也常引起血小板低下,如登革热病毒、人类免疫缺乏病毒等。此外血小板低下也常见于脾脏肿大病人,如肝硬化病人因门脉高压引起脾脏肿大,造成血小板破坏增加。
第三页,共六十页。
Evaluationofachildwiththrombocytopenia
Plateletcount<150,000cells/uL,age>3mouths
CBC,bloodsmearevaluation
Anemia+thrombocytopenia
pancytopenia
Plateletclumpspresent
pseudothrombocytopenia
Illappearing?
No
Congenitalanomalies?
Yes
No
PMNhypersegmentationRBCmacroovalocytosis? ↓B12or↓RBCfolate
B12orfolatedeficiency
MedicationsImmunizationsIrradiation Toxins?
No
Yes
Macrothrombocytes
Drug-induces Liveimmunization Irradiation Toxins
Yes
No
Othermorphologicplateletchanges
Nootherplateletchange
Bonemarrow
Cyanoticheartdisease Fanconianemia Dyskeratosiscongenita Trisomy13or18 Syndromes: Kasabach-Merritt TAR Alportvariants
Syndromes:
May-hegglin Hermansky-Pudiak Grayplatelet
ITP Hereditarythrombocytopenia Bernard-Soulier
↑NImegakaryocytes
↓megakaryocytes
Leukemia Aplasticanemia Drug-induced Amegakaryocyticthrombocytopenia Myelodysplasia
ITPisadiagnosisofexclusion Responsetotherapy,ifneeded(corticosteroid,IVIG,anti-Dantibody),confirmsthediagnosis
Yes
PTT,PT,TT
prolonged
DIC R/Osepsis
SeeConsumptionalcoagulopathy
Normal
↑↑Spleen Signsofportalhypertension platelet>50,000 +/-pancytopenia
Male Eczema Recurrentinfection Smallplatelets
Lymphadenopathy Hepatosplenomegaly Superiorvenacavasyndrome Abdominalmass
Chronicallyillappearing
Acute, fibrileillness
WBCenzymeassays Ultrasonography Thicksmear
Biopsyoflymphnode,massorbonemarrow considertumorlysisandsuperiorvenacavasyndromes
HIVassay ANA U/A Renalfunctio