HI CHNG XUT HUYT MC TIU 1. 2. 3. 4. Nu 3 nhm nguyn nhn xut huyt Trnh by c im xut huyt ca tng nguyn nhn Phn tch CLS gip chn on nguyn nhn
xut huyt Hiu c tm quan trng ca vic tm nguyn nhn gy xut huyt XUT HUYT S ph v c ch cm mu v ng mu. 1. CM MU BAN U 1. Thnh mch 1 2. Tiu cu: S lng Cht lng
2 2. NG MU HUYT TNG 3. Yu t ng mu Xut huyt 3 NGUYN NHN
Xut huyt do nguyn nhn thnh mch Xut huyt do nguyn nhn tiu cu Xut huyt do ri lon qu trnh ng mu THNH MCH Vim mch mu do nhim khun, bnh h
thng D dng thnh mch: bnh Rendu Osler Thnh mch yu: ln tui, vit C, bnh mn Ban xut huyt d ng: Henoch-Schnlein
THNH MCH Lm sng: Xut huyt t nhin da Hnh dang: chm, nt V tr: u xa chi i xng 2 bn
Lact (+) Henoch - Schnlein Henoch - Schnlein RENDU OSLER TIU CU Ri lon s lng tiu cu
Gim s lng tiu cu Tng s lng tiu cu: a tiu cu nguyn pht Ri lon cht lng tiu cu Ri lon chc nng tiu cu di truyn Ri lon chc nng tiu cu mc phi
TIU CU Lm sng: Xut huyt t nhin, sau va chm, tim chch V tr: da, nim, tng Hnh dng: chm, nt, mng Bng p cm mu (+)
XUT HUYT DI DA XUT HUYT DI DA XUT HUYT DI DA XUT HUYT NIM MC TNG RI LON NG MU
Ri lon ng mu bm sinh Di truyn ln lin kt NST gii tnh: VIII, IX Di truyn ln lin quan NST thng: yu t XI Di truyn tri lin quan nhim sc th thng Phi hp: cc bt thng trn kt hp vi nhau Ri lon ng mu mc phi Thiu Vitamin K Suy gan ph hy yu t ng mu: DIC, tiu si huyt Cc yu t c ch ng mu: khng th S NG MU HUYT TNG Hoi t t chc (m)
Tn thng thnh mch H thng ng chm XII XI Thromboplastine m (III) Pf3 + Ca++ IX VIII VII
X Ni sinh = TCK V II I Pf3: phospholipid TC, yu t 3 TC Ngoi sinh = TQ Thrombin XIII Fibrin S
Ca++ Fibrin I RI LON NG MU Lm sng: Xut huyt sau chn thng, va chm
V tr: c, khp, tng Hnh dng: mng bm ln trn da T/s: bn thn, gia nh LM SNG CHY MU DI TRUYN
Khi pht: mi sinh, hay cn nh Tin s gia nh: (+) CLS: bt thng Gim, bt thng mt yu t ng mu BNH L CHY MU MC PHI c im ni bt: c th chy mu lan ta
Lm sng: t nng hn bnh l di truyn Ni bt vi LS ca cc bnh l gc Ngoi ra, cn kho st v tin s dng thuc CN LM SNG HC XUT HUYT
Kho st cm mu ban u Kho st giai on ng mu huyt tng Xt nghim khc gip chn on nguyn nhn: ty thuc nguyn nhn. 1. CM MU BAN U 1. Thnh mch
1 2. Tiu cu: S lng Cht lng 2 2. NG MU HUYT TNG 3. Yu t ng mu Xut huyt
3 CLS CM MU BAN U Thi gian mu chy (TS) Kho st sc bn mao mch (nghim php Lacet) m s lng tiu cu
Quan st hnh thi v tp trung tiu cu trn tiu bn nhum giemsa Thi gian co cc mu Cc xt nghim kho st chc nng tiu cu: o kt dnh v ngng tp tiu cu XT NGHIM CM MU K U TP TRUNG TIU CU TNG
TP TRUNG TIU CU GIM XT NGHIM CM MU K U BT THNG HNH DNG TC BT THNG HNH
DNG TC XT NGHIM CM MU K U CLS NG MU HUYT TNG
Thi gian mu ng (TC) T l prothrombin (TP70%)) Thi gian Quick: 12 14 (bt thng >2) Thi gian thromboplastin tng phn (PTT Partial thromboplastin time) Thi gian thromboplastin tng phn hot ha (aPTT activated Partial thromboplastin time): 30 40 Thi gian thrombin (TT Thrombin time): 15 18 nh lng cc yu t ng mu nh lng fibrinogen: 200 400 mg%) (2 4 g/L)
Prothrombin time ( TQ) Tissuefactor Ca+2 F VII common pathway Extrinsic pathway Tissue factor+CaCl2 FX,FV,Ca+2 II
IIa I Ia 1. BT : 12-14, Bat thng > chng 2 prothrombin BT : 70-100% Bat 2. Taux de thng< 60% 3. INR ( International Activated partial thromboplastin time (TCK)
Intrinsic pathway Kaolin, celite, ellagic acid FXII, FXI FIX, FVIII Ca+2 Phospholipid and Ca+2
cephalin Common pathway FX,FV,Ca+2 II IIa I Ia BT : 30-50 giay . Bat thng > chng 10 giay
CHN ON NGUYN NHN BNH SLTC TS TP TCK BT
BT/ BT BT Gim SLTC BT/ BT
BT Gim CLTC BT BT/ BT BT Hemophilia
BT BT BT vW BT BT/
BT BT/ Thiu Vit. K BT BT BT/
Suy gan BT BT
Henoch-Schnlein DIC TNH HUNG 1 Bnh nhn n, 20t vo vin v chy mu chn rng, rong kinh. T/s: khe. XN: PLT (SLTC): 20 k/L
TS: 7 TP: 70%) apTT: 33 Ngh n bnh g? TNH HUNG 2 Bnh nhn n 60t, vo vin v mng bm vng mng tri lan rng xung mt sau i sau khi tim bp. T/s: x gan 2 nm ang iu tr. XN: PLT (SLTC): 110 k/L
TS: 5 TP: 42%) apTT: 63 ngh n bnh g? TNH HUNG 3 Bnh nhn n 16t, vo vin v ni nhng chm cng chn 2 bn. T/s: trc nhp vin 3 ngy vim hng. XN: PLT (SLTC): 280 k/L TS: 8
TP: 88%) apTT: 33 Ngh n bnh g? TNH HUNG 4 Bnh nhi nam 12 thng tui vo vin v xut hin chm, nt xut huyt t chi + chy mu mi. T/s: t lc sinh thnh thong xut huyt di da PLT (SLTC): 180 k/L TS: 10
TP: 100%) apTT: 53 Yu t VIII, IX: bnh thng Ngh n bnh g? TNH HUNG 5 Bnh nhn n 60 tui vo vin v mng bm da+chy mu chn rng. T/s: vim phi iu tr Amoxciline 10 ngy, n ung km PLT (SLTC): 150 k/L TS: 4
TP: 48%) apTT: 50 Test Koler (+) Ngh n bnh g? CHN THNH CM N!
