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PTI Category: Health & Medicine (/category/HealthMedicine) | Oct 17, 2017 AdChoices

Fatty Liver Treatment Doc PTI Patient Care Treatment for Lupus

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Fatty Liver Treatment

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PTI

Patient Care

Treatment for Lupus

Patient Treatment

Description 1. TROMBOCITOPENIA asociado al EMBARAZO Pedro García Lázaro Hematólogo clínico HNAAA Chiclayo,10 de julio del 2007 2. TROMBOCITOPENIA Y EMBARAZO:EPIDEMIOLOGIA…

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1. TROMBOCITOPENIA asociado al EMBARAZO Pedro García Lázaro Hematólogo clínico HNAAA Chiclayo,10 de julio del 2007 2. TROMBOCITOPENIA Y EMBARAZO:EPIDEMIOLOGIA

• Estudios prospectivos (nivell evidencia III): plaquetas 120,000-150,000/ul no son incomunes III-trimestre

• Afecta al 7% de todos los embarazos

• 1357 embarazadas-parto a término:

• Promedio: 225,000/ul

• Intervalo confianza 95%:109,000-341,000

• Disminución fisiológica

3. DIAGNOSTICO DIFERENCIAL

• Isolated thrombocytopenia

• Gestational :74%

• Immune (ITP) :4%

• Drug-induced

• Type IIb von Willebrand disease

• Congenital

• Thrombocytopenia associated with systemic disorders

• Pregnancy-specific : 21%

• Preeclampsia

• HELLP (hemolysis, elevated liver function tests, low platelets syndrome)

• Acute fatty liver

4. DIAGNOSTICO DIFERENCIAL

• Not pregnancy specific :

• Thrombotic microangiopathies:

• Thrombotic thrombocytopenic purpura (PTT)

• Hemolytic uremic syndrome (SUH)

• Systemic lupus erythematosus (LES)

• Antiphospholipid antibodies (SAF)

• Disseminated intravascular coagulation (CID)

• Viral infection (human immunodeficiency virus [HIV],EpsteinBarr

• virus [EBV], cytomegalovirus [CMV])

• Bone marrow dysfunction

• Nutritional deficiency

• Hypersplenism

5. GUIA PTI-2003

• GUIDELINES FOR THE INVESTIGATION AND MANAGEMENT OF IDIOPATHIC

• THROMBOCYTOPENIC PURPURA IN ADULTS, CHILDREN AND IN PREGNANCY

• British Journal of Haematology, 2003, 120, 574–596

6. NIVELES DE EVIDENCIA

• Ia Evidence obtained from meta-analysis of randomized controlled trials

• Ib Evidence obtained from at least one randomized controlled trial

• IIa Evidence obtained from at least one well-designed controlled study without randomization

• IIb Evidence obtained from at least one other type of welldesigned quasi-experimental study*

• III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlated studies and case studies

• IV Evidence obtained from expert committee reports or opinions and ⁄ or clinical experience of respected authorities

7. GRADOS DE RECOMENDACIÓN

• A Requires at least one r andomized controlled trial as part of a body of literature of overall good quality and consistency addressing specific recommendation

• Evidence levels Ia, Ib

• B Requires the availability of well-conducted clinical studies but no randomized clinical trials on the topic of recommendation

• Evidence levels IIa, IIb, III

8.

• C Requires evidence obtained from expert committee reports or opinions and ⁄ or clinical experiences of respected authorities. Indicates an absence of directly applicable clinical studies of good quality

• Evidence level IV

9. LABORATORIO:PLAQUETAS75% todos los casos trombocitopenia –embarazo

• Patogenesis:Efectos de hemodilución o depuración acelerada de plaquetas x mecanismos inmunes o no inmunes.

• CARACTERISTICAS:

• trombocitopenia leve (raro < 80,000/ul)

• Gestantes saludables con resto cuentas sanguíneas normales

• Ocurre comúnmente en III trimestre

• Plaquetas normales antes y después del embarazo

• No se asocia con hemorragia materna

11.

• No se asocia con hemorragia fetal o neonatal

• Trombocitopenia Gestacional es díficil distinguir de PTI:

• cuando trombocitopenia es identificada por primera vez durante embarazo

• cuentas previas de plaquetas:no están documentadas, no historia previa de PTI

• MANEJO

• Cuidado obstétrico estandar

• Parto con analgesia epidural si lo requiere

12. Púrpura trombocitopénica inmune

• Causa mas común de trombocitopenia significativa en I trimestre

• 1 caso x 1000 embarazos

• 5% de casos de trombocitopenia-embarazo

• PATOGENESIS:

• Anticuerpos contra glicoproteínas plaquetarias GPIIb/IIIa y GP Ib/IX

• Depuración de estas plaquetas cubiertas por Ig-G x RES

13. PTI: DIAGNÓSTICO

• Diagnóstico por exclusión

• Historia previa de trombocitopenia

• Trombocitopenia moderada a severa: 20 x 109 ⁄ l do not need treatment until delivery is imminent

• Platelet counts >50 x 109 ⁄ l are safe for normal vaginal delivery in patients with otherwise normal coagulation

• Platelet counts > 80 x 109 ⁄ l are safe for caesarean section, spinal or epidural anaesthesia in patients with otherwise normal coagulation

16. Recommendation: (All Grade C)

• In women who need treatment , both oral
  
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