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KELAINAN TROMBOSITdr. Aulia Syavitri D.

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FUNGSI TROMBOSIT :

Menutup luka

gumpalan trombosit (pada tempat kerusakan pembuluh darah)

Membuat faktor pembekuan

(faktor trombosit dan trombostenin untuk

memperkuat gumpalan trombosit di samping fibrin)

Mengeluarkan serotonin(untuk kontraksi pembuluh darah) dan

ADP (untuk mempercepat pembentukan gumpalan trombosit)

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KUANTITAS :

Jumlah turun

(trombositopenia) :

- produksi >

(di Limpa)

Jumlah meningkat

(trombositosis)

KUALITAS :

(trombositopati) :

Primer

Sekunder

Fungsi yg terganggu :

Adesi

Release

Agregasi Koagulasi

GANGGUAN TROMBOSIT

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Jumlah trombosit < 100.000/mm

3

petekia,

ekimosis ,dan

perdarahan abnormal lain

Jumlah trombosit < 20.000/mm3

hematemesia,hematuria, dan

melena

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TROMBOSITOPENIA Jumlah trombosit

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KELAINAN FUNGSI TROMBOSIT HEREDITER

Kelainan Laboratorium

Kelainan adhesivon Willebrand synd vWF, Platelet aggregation

Bernard-Soulier synd vWF, Platelet aggregation

Collagen disorders BT, normal platelet aggregation

Kelainan agregasi

Glansmanns thrombastheniaBT, platelet aggregation, GP IIB-IIIA

Afibrinogenemia BT, platelet aggregation, fibrinogendll

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diah

KELAINAN TROMBOSIT DIDAPAT

(mengganggu fungsi trombosit)

Obat (aspirin, indometasin, ibuprofen, penisilin)

Antibodi trombosit

Penyakit ginjal

Myeloproliferative disordersMyeloma

Fibrinolysis

Macromolecules

Fibrin split product

Monoclonal proteinsIn vivo release

hypothyroidism

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GANGGUAN TROMBOSIS

HEREDITER

Sistem Kelainan

Serine protease inhibitor Defisiensi Antitrombin III(SERPINS) Def. Heparin kofaktor II

Sistem fibrinolitik Def. Protein C heterozygous

Def. Protein C homozygous

Def. Protein S heterozygous

Trombosit Hyperactive platelet synd

Miscellaneous dll

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Gangguan Trombotik Didapat

Kondisi sistemik : Kelainan hemostatik :

Atherosclerotic vascular disease Lupus anticoagulant

diabetes mellitus DIC

malignat neoplasma Thrombotic thrombocyto-

myeloproliferative disorders penic purpuraparoxismal nocturnal hemoglobinuria Hemolytic-uremic synd

estrogen & oral contraceptive Snake venoms

Pregnancy Coagulation factor-

venous stasis concentrates

nephrotic syndromehyperlipidemia

artificial vascular prostheses

hyperviscosity

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DISSEMINATED INTRAVASCULAR COAGULATION

(DIC)

INITIATING STIMULUS

THROMBIN PLASMIN

FIBRIN PLATELET FACTOR FIBRINOLYSIS

FORMATION ACTIVATION CONSUMPTION

MICROVASCULAR HEMORRHAGE

THROMBOSIS

FIBRINOGEN PLATELET

DEPLETION DEPLETION

HEMORRHAGE

ACTIVATION ACTIVATION

Brandt 1999

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DIC STIMULATOR :

1. Tissue factor coagulants :

trauma

hemolysis

carcinoma

2. Factor producing platelet aggregation :

septicemia

uremia

immune complexes

3. Endothelial damage :

burn

vasculitis

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PEMERIKSAAN LABORATORIUM

TES SKRINING :

Jumlah & morfologi menilai primary

trombosit hemostatic plug

Bleeding time

TES KHUSUS :

Fungsi trombositadesi

sekresi

agregasi

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TES SKRINING PRIMARY HEMOSTATIC PLUG

(TROMBOSIT-VASKULER )

Tujuan : menentukan kelainan trombosit / vaskuler

TROMBOSIT :

omorfologiojumlah

ofungsi

Capillary resistance test (Rumple-Leed test)

Bleeding time (Ivy ; Duke)

20

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RUMPLELEEDE TEST

(Capillary resistance test)

VOLAR(dibaca 15 menit setelahTekanan dilepas)

HASIL :(-) : jumlah ptekiae < 1010-20 : meragukan(+) : > 20

POSITIF :1. Trombositopenia2. Gangguan vaskuler3. Gangguan fungsi trombosit

Systole

Diastole

5minutes

(100 mmHg)

21

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BLEEDING TIME / BT

(waktu perdarahan)

BT menilai Pembentukan hemostatic plug

1. Kelainan trombosit2. Kelainan vaskuler

Normal (Duke) : 1-3 menit

Memanjang :1. Kelainan konstriksi vaskuler

2. Trombositopenia3. Gangguan adhesi trombosit4. Gangguan pelepasan ADP trombosit5. Gangguan aggregasi trombosit6. Gangguan avaibilitas PF3

22

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40mmHgCupingtelinga

Volar

Cara DukeNormal

1-3 menit

Cara IvyNormal

1-7 menit

Normal Abnormal

(memanjang)

1

12 2

3

Start Start Bleeding timemenilai :

Dacie et al. 1975, Hirsh et al. 1979, Sirridge et al. 1983

Kertassaring

Bleeding Time

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