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• 11 + 0.1*(Age in Years)
• Examples
– 3 y.o. boy with a Hgb of 11.4 g/dL is normal
– 6 y.o. girl with a Hgb of 11.4 g/dL is abnormal
Rule of Thumb
• 70 + (Age in Years)
• Examples
– 3 y.o. boy with an MCV of 74.2 is normal
– 6 y.o. girl with an MCV of 74.2 is abnormal
Classification of Anemia
• Mechanism
– Decreased production
– Hemolysis
– Blood loss
• 80- 100 fl
• Microcytic Anemia
• Normocytic Anemia
• Macrocytic Anemia
Hypoproliferative Anemia
• Microcytic
– iron deficiency anemia
– thalassemia
– sideroblastic anemia
– anemia of chronic disease
• Macrocytic
– Megaloblastic anemia
– reticulocytosis
Hemolytic Anemia
• Impaired Fe utilization
– low Fe, low transferrin, high ferritin
• Increased iron stores
Megaloblastic Anemia
• G6PD
• Pyruvate Kinase
Autoimmune Hemolytic Anemia
Resting vWF
Platelets Platelet
Adhesion
PLATELET ACTIVATION
TxA2, ADP,
Serotonin,
Fibrinogen,
Thrombospondin
Platelet Platelet
Activation Release
PLATELET ACTIVATION
Platelet
Plug
אבחנה מבדלת
Ecchymoses + +
/Hematomas
הפרעה בטסיות
• הרס של טסיות
• Immune
– Idiopathic thrombocytopenic purpura (ITP)
– Secondary
• Non immune
– Microangiopathic hemolytic anemia
• Hemolytic uremic syndrome (HUS)
• Thrombotic thrombocytopenic purpura (TTP)
• Disseminated intravascular hemolysis (DIC)
ITP
Idiopathic thrombocytopenic purpura
• חריף-
– 80%מהילדים
– חולף תוך חצי שנה
– לרב אירוע בודד ,אך לעיתים אירועים חוזרים
• כרוני-
– אחוז גבוה חולף לאחר שנה-שנתיים
– עלול להתפתח להפרעות אוטואימוניות נוספות
- ITPטיפול
XI XIa
VIII VIIIa
X Xa
Vitamin K dependant factors
V Va
II IIa (Thrombin)
Fibrinogen Fibrin
בדיקת תפקודי קרישה
thromboctyopenia (consumption)
activation of intrinsic hemorrhage
pathway of coagulation
(systemic thrombin depletion of physiologic anticoagulants
generation)
decreased fibrinogen
generalized intravascular
fibrin deposition microangiopathic hemolytic anemia
thrombosis/infarction
activation of
fibrinolytic system
increased FDP and D-dimer
(systemic plasmin
generation)
Treatment of DIC