?????????? ??????? the haemorrhagic disorders

1
?????????? ??????? the haemorrhagic disorders

• ?? ?????????? ??????? ?? ?????? ?? ?????????? ???
  ?????? ????????? ???????? ???? ???? ??? ???? ???
  ??? ????? ????? ???? ??? ??? ?? ????????? ???????
  

2
????????? ????????

• ???? ?????????? ??????? ??????? ??
• ?????? ??????? ?? ??????? ???????? ??????
  ???????? ????????
• ?????? ??????? ??? ?????
• ????? ?? ???? ?? ????

3
?????? ?????????

• ????? ????? ????? ???? ??? ????? ??????? ???????
  ??
• ???????
• ????????
• ????? ??????
• ??? ???? ??????? ?? ??? ????? ????? ??? ?? ??? ??
  ????? ???? ??? ???? ?????? ????

4
?????????? ??????? ??????? ????? ??????

• ??? ???? ?????????? ?????? ?? ???????? ????????
  ????? ?????? ??????? ???? ?? ???? ????? ????
  ??????? ?????????? ???????? ??? ????? ? ???????
  ???????? ????? ??????????? ???? ?????? ????
  ?????????? ???? ??? ?????? ?? ??????

5
???????? Aquired

• ?????? ?????? Simple easy bruizing
• ???????? ??????? Senile purpura
• ???????? ???????? ??????? Symptomatic
  vascular purpura

6
????? ?????? ??

• ?????????
• ???????
• ?????????
• ????? ?????? ?? ??? ????? ???????????? ???????
• ????? ????? ??? ????
• ?????? ?????? orthostatic purpura
• ?????? ????????? mecanical

7

• ????? ??????? fat embolism
  
• ?????????? ???????? ???????? systemic
  disorders
• ???????? ??????? ???????? hereditary
  haemorrhagic telangiectasia
  
• (osler- rendu-weber disease)
• ??????? ???????? ???????? hereditary capillary
  fragility
• ????? ehlers- danlos

8
?????????? ??????? ??????? ???????
????????

• ??? ???????? thrombocytopenia
• ?? ???????? ??? ????? ???????? ?? ??? 150,000

9
????? ????? ???????? ??????

• ?????? ????? ????? ??? ????? ???????? ? ??? ?????
  ????? ????? ???? ???
• ??? ??? ??????? lt 80000 ?????? ??????
  ???????(???? ???)
• ??? ??? ??????? gt 30000 ???? ????? ???????
• ??? ??? ??????? gt 10000 ???? ????? ?????? ?????
• ??? ??? ??????? ??? 80000-40000 ?????? ??? ?????
  ????? ???? ?????? ?????????? ??????? ????????
  ??????? ?????? ???????

10
??????? ?????? ???? ????????

• ????
  Primary
• ??? ???????? ??????? Idiopathic
  thrombocytopenia
  
• ????? secondary
  
• ????? ??????? ?????? ?????? ?????
• ??????? ??????? ??????????
• ??????????
• ??? ???? ???? ????
• ?????? ?????
• ??? ????????
• ?????? ????????

11

• ??? ??????? ????? ??????
• ??? ???? ??????
• ???? ?????
• ????????
• ??? ???? ??????
• ??? ??????? ???????
• ?????? ??? ???????? ??????? TTP
• ??? ???????? ?????? ???????
• ??? ?????????? ???????
• ???????????????

12
???????? ???????? ??????? Qualitative platelet
disorders

• ??? ???? ??? ????????
• ?????? ???? ?? ??? ???????? Thrombasthenia
  
• ???????? ???? ?? ?????? ????????Thrombocytopathy
• ??? ????? ?? ???????? ?????? ?? ??? ???? ????????
  ??? ?????? ??? ????? ?? ???????? ??????? ?? ???
  ???? ???????? ??? ????? ?????? ???? ???? platelet
  factor
• ???? Anti-heparin ???????? ?? ADP ?????? ????
  ????? ?? ?????? ????? ??????

13

• ?? ???? ???????? ?????? ?????? ?? ???????
• ???? ?????Glanzman ????? ??? ???????? ??????
  ????????? ???? ????? ???? ?? ??? ??????? ?????
  ??????? ????? ?????? ???? ?? ????? ?????? ???????
  ???????
• ????? ?????? ?????? ??????? Uraemia
• ???? ????????? , ?????? ???????? ????? ???
  ???????? ???????

14
??? ???????? Thromboctytosis

• ?? ??? ???????? ?? ???? ????? ?? ???? ?????? ???
  ?? ????? ??
• ??? ???????? ?????? Primary thromocytharmia
• ??? ?? ????? ????? ?????????
  Myeloproliferative marrow disorders
  
• ???? ???? ?????? ???? ?????? ????? ???????? ???
  ???? ?? ????? ??????? ? ????? ?????? ???????
  ???????? ????????? ???? ???? ???? ?????? ???????

15

• ??? ???? ??????? Thrombosis ????? ?? ??????
  ??????? ???????? ??? ?????
• ?????????? ??????? ??????? ?? ?????? ????? ??????
• ???? ??????? ??????? The normal haemostatic
  mechanism
• ?? ??????? ?? ??????? ???? ????? ?????? ??? ????
  ?? ?????? ??? ???? , ?? ????????? ?????? ??
  ??????? ????? ????? ??????? ?????? ????? ??? ????
  ????? ?????? Feed back ????? ????? ????? ????
  ???????? ????? ???? ????? ?????? ??? ????? ??????
  

16

• Blood coaglutionfactors
• Foreign surfaces
• Tissue factor
  
• Fluid Blood Fibrin clot
  Intact vascular
  endothelium
• Inhibitors of coagulation
• Fibrinolytic system

17
?? ?????? ???? ?????? Coagulation system

• ????? ?????? , ????? ? ????????
• ?????? ???????? Foreign surfaces
• ????? ??????? (?????? ????? ) Tissue factor
• ???? ????? ?????? ??? ??? ????? ?? ??? ????? ????
  ????? ???? ?? ??? ????? ??? ????? ?????? ???
  ??????? ???????? subendothelial collagen ??
  ????? ???? elastic fibers ?? ??? ????? ???????
• ??? ?????? ???? ?????? ?????? ?? ????? ??????
  ???? ??? ??? ????? ???? ?????? coagulation cascade

18
(No Transcript)
19

• ???? ???? ??? ??????? ?? ?????????? ??????? ????
  ???? ?? ??? ??? ????? ?????? ??????? ??????
• ??????? haemophilia
• ??? ???? ?? ??? ?????? ?????? Vlll ??????? ??
  AHF
• Anti Haemophilic Factor
• ???? ??????? ???? ??????? A ???????? ????
  ?????? ??????? ?????? ?? ???? ??????? ???????

20

• ???????? B ??? ???? ?? ??? ?????? ?????? lX
  ?????? ???? ??????? ??????? ??? ??? ?????? ??
  ??????? A ???? ???? ???????
• ????? ??? ????? ??? ???? ????? ?? ?????? ??????
  ?? ?????? ????? ?????? ??? 0 ??? 30
• ???? ?????? ?? ????? ??? ??? ?????

21

• ??? ??????? ???????? ??? ??? ???? ?? ???? ?????
  ?? ?????
• ??? ???? ?????? ?? ???????? ?? ??????? ? ????
  ????? ?????? ?????? ?????
• ??? ????? ??? ?????? ???? ????? ?? ?????
• ??? ???? ??? ?????? ??????? ?? ???????

22

• ????? ??????? ??? ?????? ?????? ?????? ?? ??????
  ?? ??????? ? ?????? ?????? ?? ????? ??? ???????
  ???????
• ????? ???????? ?????? ?????? ??????
• ?????? ???????? ????? ???? ?? ??? ??????? ??????
  ?????? ????? ???????? ?? ?????????

23
??? ??? ?????????? Von Willbrands Disease

• ??? ?????? ???? ????? ???? ??????? ????? ??? ???
  ????? ???? ????? ???????? ????? ???????
• ???? ??????? ??????? ???????? ??????? ???? ??
  ????? 36 ???? .
• ??? ?????
• 1- ?????? ????? ?? ??? ?? ????? ????????
• 2- ??? ?????? ??????

24
?????????? ??????? ???????? Acquired Coagulation
Disorders

• ????? ???? ??? ???? ??????
• ??? ????????? K
• ???? ?????
• ??????? ??????? ??????
• ?????? ?????? ???? ??????? ?? DIC
• ?????? ???????? ?????? ?????

25
??? ????? ?????

• ??? ??????? ???? ???? ???? ??????? ???? ??? ??
  ???? ??? ???
• ?? ????? ???? ?? ???? ????? ?????? ?? ?????? ????
  ?? ??????? ????
• ??? ??? ??? ????? ???????? ?????? ??? ?? ??????
  ??????(???????? ?? ??????? ??????? ?? ?????
  ??????)
• ???? ?????? ????????? ???? ???????? ?????? ?????
  ??? ??? ????? ???????? ???????? ???? .