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● Thrombocytopenia
– Due to portal hypertension and splenomegaly
● Intravascular coagulation
– Reduced synthesis of ant III and Protein C
Acquired coagulation defects
Liver disease- lab
Parameter Result
● PT and INR prolonged
● Platelet number and function Low
● Bleeding time Prolonged
● Fibrinogen and Low
individual factor levels
Acquired coagulation defects
Liver disease- Treatment
● Coagulation defects
– FFP or factor concentrates
● Thrombocytopenia
– Platelet concentrates
● Increased fibrinolysis
– Antifibrinolytics
– FFP
DIC
● Systemic process producing both thrombosis
and haemorrhage
● Its initiated by a number of defined disorders
– Exposure of blood to procoagulants such as tissue
factor and cancer procoagulant
– Formation of fibrin within the circulation
– Fibrinolysis
– Depletion of clotting factors
– End- organ damage
Diagnosis of DIC
DIC Management
● Correct underlying disease and initiating factor
● Replacement therapy
– FFP
– Platelet transfusion
– Inhibit clotting process
● Tranexamic acid
● Heparin
Vitamin k deficiency
Fat soluble vitamin
● Platelet dysfunction
– Congenital ( Glanzmann´s syndrome, Bernard-
Soulier)
– Acquired ( Drugs, aspirin)
Platelets disorders
Diagnosis of platelet disorders
Blood count film
● Low platelet ● Normal Platelet count
– Bone marrow – Bleeding time
examination – Platelet aggregation
– Platelet antibodies studies with ADP,
– Screening tests for adrenaline, collagen
DIC and ristocetin
– Other special platelet
tests, e.g. adhesion
studies, nucleotide
pool measurement
Vascular abnormalities
● Inherited ● Acquired
– Osler weber Rendu – Henoch Schnonlein
Disease purpura
– Inherited disorders of – Haemolitic uraemic
connective tissue syndrome
matrix – Drug reaction
– infections
Thrombosis
Thrombosis
screening tests
● Blood count
● PT and APTT ( shortened)
● D- dimers
Thrombosis
treatment
● Antiplatelets ● Anticoagulants
– Aspirin – Heparin
– Clopidogrel ● UH
– GPIIb/IIIa inhibitors
● LMWH
– Coumarins
● Thrombolytics ● Warfarin
– New drugs
– streptokinase
● Fxa inhibitors
● Direct thrombin
inhibitors
References
● Robbins basic pathology
● Up to date, 2017