Thrombocytopenia from surgical view

Thrombocytopenia from surgical view

thrombocytopenia means a platelet number less than 150,000
  • Causes of thrombocytopenia
  • platelet production failure as in aplastic anaemia drugs like cytotoxics alcohol viral infections as EBV, CMV  bone marrow infiltration as in leukaemia , myelofibrosis myeloma metastatic infiltration hereditary thrombocytopeniah
  • decreased platelet survival as in idiopathic thrombocytopenic purpura(ITP)  drugs like heparin penicillamine gold .infections as in subacute bacterial endocarditis meningococcus , thromboletic thrombocytopenic purpura(TTP), DIC  blood transfusion cause dilutional thrombocytopenia , haemolytic uraemic syndrome (HUS)  extracorporeal bypaass platelets are activated in the extracorporeal circuit and are therfore ineffective in haemostasis 
  • sequestration of platelet as caused by hypersplensim or count of less than 70.000 are inadequate for surgical haemostasis and spontaneous bleeding may occur with platelet numbers of <20,000
  • Clinical conditions in thrombocytopenia
  •  platelet dysfunction excess surgical bleeding  may occur with a normal platelet number due to platelet dysfunction . the commonest cause in surgical practice is antiplatelet medications such as aspirin clopidrogrel and warfarin patients should be advised to stop theses preoperatively . aspirin in particular should be stopped 14 days preoperatively
  • dissemintated intravascular coagulation(DIC) simultaneous activation of both the coagulation and fibrinolytic systems in the body causes widespread microvascular thrombosis fibrin deposition and bleeding due to the consumption of clotting factors and fibrinolysis
  •  ,  thrombotic thrombocytopenic purpura (TTP) this is a condition of unknown cause usually affecting young adults deposition of wide hyaline thrombi in small vessels causes microangiopathic haemolysis,renal failure and neurological distrubance
  • haemolytic uraemic syndrome(HUS) usually this occurs post acute illness especially  urinary tract and gastrointestinal tract infections Escherichia coli has been implicated . characteristics include a microangiopathic haemolysis , thrombocytopenia and acute renal failure 
  • idiopathic thrombotic purpura(ITP)  autoimmune destruction of platelets due to IgG antibody attack . two type exist 1- acute which occurs in children , postviral usually self limiting ;henoch- schonlein purpra 2- chronic occurs in adults female predominance treated with high dose steroids rarely requires splenectomy
tags:thrombocytopenia,view,surgical

0 comment:

Post a Comment