Disseminated Intravascular Coagulation DIC

-Is a pathological process characterized by the widespread activation of the clotting cascade that results in the formation of blood clots in the small blood vessels throughout the body

-Symptoms & Signs :

.shock

.amniotic fluid embolism

.multiorgan failure

.widespread bleeding

-Causes disseminated intravascular coagulation :

.Gram negative septicemia

.Falciparum malaria

.solid tumors and blood cancers (particularly acute promyelocytic leukemia)

.obstetric complications: abruptio placentae, preeclampsia or eclampsia, amniotic fluid embolism

.trauma, burns, hyperthermia, rhabdomyolysis, extensive surgery

.sepsis or severe infection (bacterial infections are the most common): bacterial (Gram-negative and Gram-positive sepsis), viral, fungal, or protozoan infections

.transfusion reactions

.severe allergic or toxic reactions (i.e. snake or viper venom)

.giant hemangiomas (Kasabach-Merritt syndrome)

.large aortic aneurysms

.liver disease

.HELLP syndrome

.thrombotic thrombocytopenic purpura

.emolytic uremic syndrome

..malignant hypertension

+The most helpful and reliable bedside platelet function is (Bleeding time)

+Stored blood is deficient in Factor 8

Heparin-Induced Thrombocytopenia HIT

-It can occur with any form of heparin

-Form of heparin :

.IV unfractionated heparin (more common )

.low molecular weight LMW

+Anticoagulant effect of heparin is based on Potentiation of antithrombin III

+The most useful test in monitoring heparin therapy is Partial thromboplastin time (PTT)

+Important uses of acetylsalicylic acid (aspirin) include :

.Acute rheumatic fever

.Antipyretic

.Transient ischemic attacks

.Mild migraine headache

+Drugs should not be given together Warfarin and aspirin

+Contraindications to the use of streptokinase therapy include (thrombolysis medication in some cases of myocardial infarction ‘heart attack’) :

.Bleeding peptic ulcer

.Infective endocarditis

.Surgery to eye

.pregnancy

.pancreatitis

.active internal bleeding

.stroke

.hypertension

.trauma

.Severe hepatic insufficiency

+Protamine sulfate anti-coagulant (heparin)

BLOOD TRANSFUSION

-Complications of blood transfusion / potential risk :

.Hypothermia

.Hypocalcemia

.Hyperkalemia

.Thrombocytopenia

.Hemolytic reactions

.Anaphylactic reactions

.Hepatitis C

.HIV infection

.Acute congestive heart failure

.Transmission of infection

.Transfusion reaction

.Acidosis

.Impaired hemostasis

.Citrate toxicity

.Impaired oxygen delivery

.Incompatibility

.Non-cardiogenic pulmonary edema

+The most fatal complication of blood transfusion is (Human error)

+Diseases are transmitted through blood transfusion :

.Syphilis

.Malaria

.Hepatitis B and C

.Epstein-Bar virus

.Helicobacter Pylori (are NOT)

+In vascular injury the immediate response that produce hemostasis is (Vasoconstriction)

+Platelets normally have a half life of (7 days)

+In human being, normal red blood cell survival time is approximately (120 days)

+Generalized increased pigmentation may be seen in (skin) :

.Chronic liver disease

.Addison disease

.Hemochromatosis

.Ectopic ACTH secretion

.Nelson's syndrome

.Hemochromatosis

.Chronic renal failure

.Primary biliary cirrhosis

+Causes of hypopigmentation (skin) :

.Albinism

.Tuberous sclerosis

.Post inflammatory

.Vitiligo

Palmar erythema

-Causes :

.Portal hypertension

.Chronic liver disease, (including chronic hepatitis)

.Pregnancy

.Polycythemia

.Thyrotoxicosis

.Rheumatoid Arthritis(especially in patients with polycythaemia)

.Eczema and Psoriasis

.Deep telangiectasias

.Coxsackievirus A infection (Hand, foot and mouth disease)

.Rocky Mountain Spotted Fever

.Secondary Syphilis

.Kawasaki disease

.Alcoholism

Splenomegaly

-Is an enlargement of the spleen. The spleen usually lies in the left upper quadrant (LUQ) of the human abdomen

-Symptoms & Signs :

.abdominal pain

.chest pain (chest pain similar to pleuritic pain when stomach, bladder or bowels are full)

.back pain

.anemia due to cytopenia

.palpable left upper quadrant abdominal mass or splenic rub.

.by physical examination (Castell's sign or Traube's space)

-Causes :

.infectious mononucleosis

.hematological malignancy (anemia,leukaemia,lymphoma)

.portal hypertension (most commonly secondary to liver disease, and Sarcoidosis)

.bacterial infections ( syphilis or an infection of the heart's inner lining endocarditis,TB)

.myelofibrosis,kala azar(leishmaniasis),typhoid fever

Lymphadenopathy

-Refers to lymph nodes which are abnormal in size, number or consistency and is often used as a synonym for swollen or enlarged lymph nodes

-Types :

.Localized lymphadenopathy (due to localized spot of infection e.g., an infected spot on the scalp will cause lymph nodes in the neck on that same side to swell up)

.Generalized lymphadenopathy (due to a systemic infection of the body e.g., influenza or secondary syphilis)

.Persistent generalized lymphadenopathy (PGL) (persisting for a long time, possibly without an apparent cause)

.Dermatopathic lymphadenopathy (lymphadenopathy associated with skin disease)

-Causes :

.infection (bacterial or viral), or chronic infections (tuberculous lymphadenitis,cat-scratch disease)

.infectious mononucleosis is an acute viral infection caused by Epstein-Barr virus

.autoimmune disease (sarcoidosis)

.malignancy

.toxoplasmosis (parasitic disease such as toxoplasmosis)

.HIV infection

.bites from certain venomous snakes such as the pit viper

.drugs (phenytoin)

**Polycythemia (erythrocytosis)

Is a disease it can due to increase in the number of red blood cells

-Causes :

.Cushing’s syndrome

.Primary hepatoma

.Heavy smoking

.High altitudes

.Hepatoma

.Right to the left shunt

.Hematoma

.Fibroma of uterus

.Massive uterine fibroma

.Renal cell carcinoma

Thrombocytopenia

-Refer to a disorder in which there is a relative decrease of thrombocytes, commonly known as platelets, present in the blood (A normal human platelet count ranges from 150,000 to 450,000 platelets per microliter of blood)

-Causes :

*Decreased production

.Dehydration, Vitamin B12 or folic acid deficiency

.Leukemia or myelodysplastic syndrome or aplastic anemia

.Decreased production of thrombopoietin by the liver in liver failure

.Sepsis, systemic viral or bacterial infection

.Dengue fever

.Hereditary syndromes (Fanconi anemia,Bernard-Soulier syndrome,May-Hegglin anomaly,Grey platelet syndrome,Alport syndrome,Wiskott–Aldrich syndrome)

*Indreased production

.Idiopathic thrombocytopenic purpura

.Thrombotic thrombocytopenic purpura

.Hemolytic-uremic syndrome

.Disseminated intravascular coagulation

.Paroxysmal nocturnal hemoglobinuria

.Antiphospholipid syndrome

.Systemic lupus erythematosus

.Post-transfusion purpura

.Neonatal alloimmune thrombocytopenia

.Hypersplenism

.Dengue fever

.Gaucher's disease

*Medication-induced

.Valproic acid

.Methotrexate

.Carboplatin

.Interferon

.Isotretinoin

.Panobinostat

.H2 blockers and proton-pump inhibitor

*Other causes

.Snakebite

.Niacin toxicity

.Lyme disease

-laboratory procedure can detect thrombocytopenia (Bleeding time)

Pancytopenia

-Is a medical condition in which there is a reduction(decreased) in the number of red and white blood cells, as well as platelets

-Causes :

.Familial hemophagocytic syndrome

.Aplastic anemia

.Gaucher's disease

.metastatic carcinoma of bone

.multiple myeloma

.overwhelming infections

.lymphoma

.myelofibrosis

.Dyskeratosis congenita

.Myelodysplastic syndrome

.Leukemia

.Leishmaniasis

.Severe Folate or vitamin B12 deficiency (megaloblastic anemia)(iron deficiency ar NOT)

.Systemic lupus erythematosus

.Paroxysmal nocturnal hemoglobinuria (blood test)

.viral infections (such as HIV, EBV--undetermined virus is most common).

.Alimentary toxic aleukia

.Copper deficiency

.Pernicious anemia

.Medication

.Hypersplenism

.Osteopetrosis

.Organic acidurias (Propionic Acidemia, Methylmalonic Aciduria, Isovaleric Aciduria)

.Low dose arsenic poisoning

.Sako disease (Myelodysplastic-cytosis)

.Chronic radiation sickness

.LIG4 syndrome

**Neutrophilia (Leukocytosis)

-Describes a high number of neutrophil granulocytes in blood / Is a white blood cell count (the leukocyte count) above the normal range in the blood

-Primary function of neutrophils is phagocytosis

-Causes :

.bacterial infection(only bacterial), so the most common cause of neutrophilia is a bacterial infection, especially pyogenic infections

.acute inflammation, so will be raised after a heart attack,other infarct (MI) or burns

.drugs, such as prednisone, have the same effect as cortisol and adrenaline (epinephrine)

.nervousness (anxiety)

.malignancy (Chronic myelogenous leukemia-leukemoid reaction)

.appendicitis

.splenectomy

Neutropenia

-Is a granulocyte disorder characterized by an abnormally low number of neutrophils

-Causes :

*Decreased production

.aplastic anemia

.arsenic poisoning

.cancer, particularly blood cancers

.certain medications

.hereditary disorders (e.g. congenital neutropenia, cyclic neutropenia)

.radiation

.Vitamin B12, folate or copper deficiency

*Increased destruction:

.autoimmune neutropenia

.chemotherapy treatments, such as for cancer and autoimmune diseases

.Marginalisation and sequestration:

.Hemodialysis

*Medications

.Flecainide (a class 1C cardiac antiarrhythmic drug)

.Phenytoin

.Indomethacin

.Propylthiouracil

.Carbimazole

.Chlorpromazine

.Trimethoprim/sulfamethoxazole (cotrimoxazole)

.Clozapine

.Ticlopidine

*Other Causes

.viral infections

Eosinophilia

-Is a condition in which the eosinophil count in the peripheral blood exceeds 4.5×10/L (increased)

-Causes :

.Allergic disorders (Asthma,Hay fever,Drug allergies,Allergic skin diseases,Pemphigus,Dermatitis herpetiformis)

.bacterial infection

.Eosinophilic esophagitis

.Eosinophilic gastroenteritis

.Parasitic infections

.malignancy (ALL,CML,Eosinophilic leukemia,Hodgkin lymphoma,non-Hodgkin lymphoma)

.Systemic autoimmune diseases (SLE, idiopathic eosinophilic synovitis)

.Systemic mastocytosis

.Some forms of vasculitis (Churg-Strauss syndrome)

.Cholesterol embolism (transiently)

.Coccidioidomycosis (Valley fever)

.Human immunodeficiency virus infection

.Interstitial nephropathy

.Hyperimmunoglobulin E syndrome, an immune disorder characterized by high levels of serum IgE

.Idiopathic hypereosinophilic syndrome

Steroids

-Prolonged use of corticosteroids may cause (complications) side effect:

.Proximal myopathy

.Metabolic alkalosis

.Avascular necrosis of the head femur

.Leukocytosis

.Hyperglycemia

.Osteoporosis

.Skin atrophy

.Weight gain

.Cataract

.Retardation of growth in children

.Osteoporosis

.Hypertension

.Peptic ulcer disease

.Acne

.Diabetes mellitus

.Delayed healing of wounds

.Adrenocortical suppression

.A papulopustular facial rash

.Purpura

.Cutaneous striae

-Corticosteroids could be used in the treatment :

.Acute leukemia

.Nephrotic syndrome

.Rheumatoid iridocyclitis

.Addison's disease

RHEUMATOLOGY

Date: 2016-04-22; view: 518