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By: Yoavita
Moderator: dr.C.L. Retno H., Sp.PK
INTRODUCTION
• Platelets were recognized in 1882 by Bizzozero as a cell
structure different from red and white cells
• In 1970, platelets’ relationship to hemostasis and
thrombosis became so important
• Every cubic millimeter of blood contains one-fourth of 1
billion platelets, resulting in approximately a trillion
platelets in the blood of an average woman
• Each platelet makes 14,000 trips through the
bloodstream in its life span of 7 to 10 day
MEGAKARYOCYTOPOIESIS
MEGAKARYOCYTOPOIESIS
• Megakaryocytes (MKs) give rise to circulating platelets
(thrombocytes) through commitment of the multipotent stem
cell to the MK lineage, proliferation of the progenitors and
terminal differentiation of MK
MK I Megakaryoblast
MK II Promegakaryocyte
MK III Megakaryocyte
MK IV Postmature multilobed, highly condensed nucleus
MEGAKARYOCYTOPOIESIS
Megakaryocyte Maturation
Small molecules
ADP
ATP
Calcium
Serotonin
Large molecules
β-thromboglobulin
Factor V, XI
Protein S β-N-acetylglucosaminidase
Fibrinogen β -N-acetylgalactosaminidase
Vwf β -Glucoronidase
Platelet factor 4 β -Galactosidase
PDGF α-Arabinosidase
PLATELET ACTIVATION
Adhesion
Quantitative Qualitative
Thrombocytopenia Hereditary
Thrombocytosis Acquired
PLATELET DISORDERS
Quantitative
Thrombocytopenia Thrombocytosis
Platelets < 100,000/μL Platelets > 450,000/μL
Impaired/decreased production Primary
Bernard Soulier syndrome Polycythemia vera
Fanconi anemia Chronic myelogenous leukemia
Viral infection Myelofibrosis & myeloid metaplasia
Drug-induced Essential thrombocythemia
Increased destruction Secondary
Immune: ITP, PTP, etc Blood loss
Non-immune: TTP, HUS, DIC, etc Chronic inflammatory diseases
Related to distribution/dilution Postsplenectomy
Splenic sequestration Iron deficiency anemia
Massive blood transfusions Stress & exercise
Kasabach-Merritt syndrome
PLATELET DISORDERS
Qualititative
Hereditary Acquired
Disorders of platelet adhesion Disorders of platelet adhesion
von Willebrand disease Chronic liver disease
Bernard Soulier syndrome Myeloproliferative and
lymphoprolifera-tive disorders
Disorders of primary aggregation Disorders of primary aggregation
Glanzmann thrombasthenia Acquired von Willebrand disease
Hereditary afibrinogenemia Uremia
Disorders of platelet secretion Disorders of platelet secretion
Storage pool disease Drug-induced
Chédiak-Higashi syndrome
Herman-Pudlak syndrome
Wiskott-Aldrich syndrome
REFERENCES
1. Ciesla B, editor. Hematology in Practice. Philadelphia: FA
Davis. 2007.
2. Rodak BF, Fritsma GA, Doig K, editors. Hematology: Clinical
Principles and Applications, 3rd ed. Missouri: Saunders
Elsevier. 2007.
3. Lichtman MA, Beutler E, Seligsohn U, Kaushansky K, Kipps
TO, editors. Williams Hematology, 7th ed. New York:
McGraw-Hill. 2005.
THANK YOU