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1、危重患者血小板减少的诊海Jinchetsecom |概述血小板减少的定义、机制、诊断思路、常用的检查方法危重患者中血小板减少的诊断和治疗总结忌持, 病例讨论 aa血小板减少 (thrombocytopenia) 定义为各种遗传或获得性因素导致的血小板减少,血小板计数150.0 X10(9)作,通常小于100.0 xX10(9)儿.其主要讯制为破坏增加hyperdestructive) 、生成减少 hypoproductive ) 和分布异常(Caltered distributiom,常见于充血性脾大或低体温) 。 Table 1, Selected Causes ofThrombocytop
2、enia Decreased plateletproductionMyelosuppression due tochemotherapy or radiationCertain infections 醒Ethanol toxicityFolate or vitamin Bi deficiencyBone marrow disorders (eg leukemia,myelodysplastic syndrome, myelofibrosis)Infiltratve diseases of the bone marrowInherited thrombocytopeniasLiver disea
3、se Hospital-acquired thrombocytopenia.Hosp Pract ,2014 Oct;42(4):142-52. thrombocytopeniaHeparin-induced thrombocytopeniaImmune thrombocytopeniaThrombotic thrombocytopenic purpuraHemolytic uremic SyndromePosttransfusion purpuraDisseminated intravascular coagulationInfection/sepsisInpa-aprtic baloon
4、pumpHELLP syndromePreeclampsiaECMOCardiopulmonary bypass Splenic sequestration Portal hypertensionOther PseudothrombocytopeniaHemodilutionGestational thrombocytopeniaAbbreviations: ECMO, extra-corporeal membrane oxygenation; HELLP hemolysis,elevated liver enzymes. and iow platelat count.Hematologic disorders 国 |血小板减少的病因多样,涉及多个学科,常规检查特异性和敏感性不高,特异性检查受到技术条件和标准化的制纹难以开展,时致诊断及鉴别诊断困难。同一病因导致血小板减少的时间、程度个体差异大,发生严重出血受到患者年龄、基础疾病 心、肝、肾等) 和有创操作等的影响,及时评估、干预非常重要。 和相关病史 (基础疾病、药物史、出血事件)查体出血倾向、肝脾淋巴结、和疫相关症病、皮肤巩膜黄染) 的血 小板聚集 (clumping) ,自动血细胞计数仪中血小板计数下降,称为假性血小扳减少(pseudothrombocytopenia)人工计数或构橡酸抗凝可以识别 裂红细胞 (破碎红细胞)