血小板减少性紫癜ppt课件_2.pptVIP

体格检查 神清，平卧位，对答切题，查体合作。 T36.8℃，BP130／80mmHg。 咽稍红，口腔内未见明显活动性渗血。浅表淋巴结未及肿大。双下肢可见散在针尖大小出血点，不高出皮面。胸骨无压痛，HR72次／分，律齐，各瓣膜区未及杂音。双肺呼吸音清，未及罗音，R16次／分。腹平软，无压痛，肝脾肋下未及。神经系统检查（－）。 病例解读 血常规： Hb 125g/l，WBC9.5×109/l，BPC 6×109/l 外周血涂片： 中性粒细胞 65%，淋巴细胞 30%，单核细胞 5% 血小板形态未见明显异常 出凝血系列 PT， KPTT， TT， Fg（-） 骨髓细胞学检查 治疗经过 日期 血常规 治疗药物 Hb WBC BPC 丙种球蛋白 地塞米松 d1 125 9.6 6 20g 10mg d2 ↓ ↓ d3 124 9.8 23 ↓ ↓ d4 ↓ ↓ d5 125 10.2 50 ↓ ↓ d6 ↓ d7 126 11.0 124 ↓ d8 ↓ d9 123 10.8 204 ↓ d10 ↓ d11 128 11.4 210 ↓ Thank you! In general, the severity and frequency of hemorrhagic manifestations correlate to the platelet count. Patients with platelet counts above 50000/ul had no significant bleeding symptoms.Platelet counts are less than 20000/ul,patients usually are associated with spontaneous hemorrhage. The clinical syndromes of ITP are divided into acute and chronic types. The frequency with which acute ITP is associated with antecedent viral infection Thrombocytopenia in ITP appears to result from the action of immunologic process. The infusion of plasma from patients with ITP into normal recipients will cause a sudden and dramatic thrombocytopenia. On the other hand, The infusion of normal platelets into patients with ITP will cause destruction of infuses BPC within 12-24h. That reveal patients with ITP often have unbound ab in their plasma. We can detect platelet associated antibody in the plasma of patients with ITP. It may be responsible for platelet sensitization and destruction in this form of the disorders. The major ab is PAIgG. The spleen also is important in ITP as a site of production of platelet antibodies. Splenic tissue from patients with ITP produces more immunoglobulin than that of normal control subjects, and a significant percentage of that formed binds to homologous platelets. When 51Cr-chromate-labeled isologous platelets are administered to patients with ITP, external scintillation counting reveals a rapid accumulation of radioactivity predominantly in the spleen. Hepatic sequ