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1、CaseDiscussionHuangHonghuiDepartmentofHematologyRenJiHospitalCaseSummary26year-old,femalepatientpersistentnasalbleedingforoneday,haveanupperrespi-ratoryinfection2weekspreviously.Nofever,chills,nausea,vomiting,abdominalpain,orjointpain.PE:multiplel-mmreddi
2、shspotsonherlowerextremities.Nolymphadenopathyorhepatosplenomegaly.Noexcessivebleedingwithmenses,childbirth,priorepistaxis,easybruisability,orbleedingintoherjoints.Nofamilyhistoryofabnormalbleeding.Nottakeanymedication.ObjectsofAnalysisLearntheclinicalapp
3、roachtobleedingdisorders,specificlyplateletsdisordersversuscoagulationdisorders.Learnaboutthedifferentialdiagnosisofthrombocytopenia,specificallythrombocytopenicpurpuraversusotherplateletdisorders,suchasthromboticthrombocytopenicpurpura(TTP),hemolyticurem
4、icsyndrome(HUS),ordisseminatedintravascularcoagulation(DIC).LearnaboutthetreatmentofITP.Considerationsuperficialpetechiaeandmucosalbleedingdisorderedprimarymaryhemostasislaboratorytestingcompletebloodcountprothrombintime(PT)screeningpartialthromboplastint
5、ime(PTT)BonemarrowsmearAPPROACHTOSUSPECTEDTHROMBOCYTOPENIAHISTORYLiverdisease,uremia,malignancy,systemiclupuserythematousMedications:over-the-counterproducts(aspirin)FamilyhistoryofabnormalbleedingHistoryofepistaxis,menorrhagia,excessiveprolongedbleedingf
6、romminorcuts,bruising,prolongedorprofusebleedingafterdentalextraction,excessivebleedingaftermajorsurgeryorobstetricdelivery,traumafollowedbybleedingconsideredexcessiverelativetotheinjuryTimingofBleedingIfbleedingfollowingdentalextractionisimmediateandlast
7、sforlongerthan24hours,aproblemwithprimaryhemostaticplugformationmaybepresent.Therefore,thismaysuggestaplateletdisorder.Ifinitialhemostasisseemednormalbutprolongedbleedingdeveloped2-3dayslater,aprobleminthecoagulationphaseissuspected.TypeofBleedingSpontane
8、ousmucusmembranebleeding,suchasgumbleeding,nosebleeding,andpetechiaearesuggestiveofavasculardisorder,thrombocytopenia,orabnormalplateletfunction.Hemarthrosis,deephematoma,andretroperitonealbleedingaremorelikelytoref
