医学专业英语课程_3资料文档.ppt

Case Discussion Huang Honghui Department of Hematology Ren Ji Hospital Case Summary 26 year-old, female patient persistent nasal bleeding for one day, have an upper respi- ratory infection 2 weeks previously. No fever, chills, nausea, vomiting, abdominal pain, or joint pain. PE: multiple l-mm reddish spots on her lower extremities. No lymphadenopathy or hepatosplenomegaly. No excessive bleeding with menses, childbirth, prior epistaxis, easy bruisability, or bleeding into her joints. No family history of abnormal bleeding. Not take any medication. Objects of Analysis Learn the clinical approach to bleeding disorders, specificly platelets disorders versus coagulation disorders. Learn about the differential diagnosis of thrombocytopenia, specifically thrombocytopenic purpura versus other platelet disorders, such as thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), or disseminated intravascular coagulation (DIC). Learn about the treatment of ITP. Consideration superficial petechiae and mucosal bleeding disordered primarymary hemostasis laboratory testing complete blood count prothrombin time (PT) screening partial thromboplastin time (PTT) Bone marrow smear APPROACH TO SUSPECTED THROMBOCYTOPENIA HISTORY Liver disease, uremia, malignancy, systemic lupus erythematous Medications: over-the-counter products (aspirin) Family history of abnormal bleeding History of epistaxis, menorrhagia, excessive prolonged bleeding from minor cuts, bruising, prolonged or profuse bleeding after dental extraction, excessive bleeding after major surgery or obstetric delivery, trauma followed by bleeding considered excessive relative to the injury Timing of Bleeding If bleeding following dental extraction is immediate and lasts for longer than 24 hours,a problem with primary hemostatic plug formation may be present. Therefore, this may suggest a platelet disorder. If initial hemostasis seemed normal but prolonged bleeding developed 2-3