医学专题血小板低下症的区分及血小板输注合理评估.pptx

血小板低下症的区分及血小板输注合理评估
张志升台湾台大医院输血医学科
2016/6/26
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2021/7/20 星期二
Content
血小板低下症的原因
新生儿血小板低下症
药物诱导血小板低下症
血栓性血小板低下症
特发mor lysis and superior vena cava syndromes
HIV assayANAU/ARenal function
Blood culture ? antibiotics
MalariaGaucher diseasePortal hypertensionHepatic schistosomiasisCavernoustransformation of the portal vein
Wiskott-Aldrich syndrome
Lymphoma: Hodgkin Non-Hodkin NeuroblastomaleukemiaMyelodysplasia
HIV Autoimmune or connective tissue diseaseHUS/TTP + other microangiopathies Prosthetic cardiac valve
R/O ADMAT-13DATAuto/allo anti-platelet antibody
SepsisVaricellaEBVCMVDenque hemorrhagic feverHIVHUSHantavirusParvovirusOther viruses TTP
Auto/all anti-platelet antibodies study
Heparin-induced thrombocytopenia
Check PF4
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2021/7/20 星期二
Thrombocytopenia in the ill neonate
Any etiology of thrombocytopenia that occurs in the well child
History, examination, CBC, blood smear evaluation
See Thrombocytopenia in the well neonate
Platelets 100,000~149,000/uL
Platelets < 100,000/uL
If platelets < 50,000? Cranial ultrasound to R/O intracranial hemorrhage resulting from severe TP of any etology
Follow platelet count
>150,000/uL  no further evaluation
100,000~149,000 continue to fellow
PTT, PT, TT
High Hb
Severe jaundice and low Hb
Prolonged PTT, PT and/or TT +/- microangiopathic hemolytic anemia:Consider D-dimer of FSP, and/or fibrinogen +/- factors II, V and VIII
PolycythemiaCyanotic congenital heart disease
Erythroblastosis fetalisExchange transfusion pphototherapy
DIC
EtologiesAcute infectionAsphyxiaRDSMeconium aspirationObstetrical complicationsShockThrombosisSevere hemolytic disease of the newbornSevere hepatic disease
TP usually mild enough not to require transfusion except in DIC due to erythroblastosis fetalis
Treat underlying disease Maintain platelets > 50,000 with transfusionsMaintain fibrinogen > and P