1. DIATHESIS
HAEMORRHAGIS

2.
HEMOSTASE

3. TRIAS OF HEMOSTASE
VASKULER
TROMBOSIT
FAKTOR.PEMBEKUAN

4. FAKTOR ---------- > HEMOSTASE

7. DIATHESIS HEMORRHAGIS
KELAINAN :
VASKULER
TROMBOSIT
FAKTOR PEMBEKUAN

8. KELAINAN HEMOSTASE

11. 5Kelainan Faktor Pembekuan dengan Kel Vaskuler dan Tromb Kel F
5Kelainan Faktor Pembekuan dengan Kel Vaskuler dan Tromb Kel F.Pemb Kel Vask& Trom 1.Epid : Turunan Turunan/didapat 2. Kelainan : Haematom Purpura/Ekimosis 3. Trauma : Lab : W.pemb > W.perd >

12. ITP 100 cases per 1 milion persons per year. Primary vs Secondary .
Acute vs Chronic ( >6 months).

13. The etiology is still unknown and the pathogenesis is complex and possibly depends on disturbed antigen presentation, T cell activation and signaling, disregulated B cell stimulation and antibodies, unbalanced activation / suppression of complement.

16. In more than 70% of children, the illness resolves within six months, irrespective of whether they receive therapy.
By contrast, ITP in adults is generally chronic.

17. The bone marrow in patients with ITP
contains normal or increased numbers of
megakaryocytes.

19. Pathophysiology ITP is mediated by IgG autoantibodies.
Glycoprotein IIb/IIa, Ib/Ix, Ia/IIa, IV and V ...
Accelerated clearance through Fcү receptors that are expressed by tissue macrophages (spleen & liver).

20. TREATMENT
The decision to treat ITP is based on the platelet count, the degree of bleeding, and the patient’s lifestyle .

21. Management
The incidence of intracranial hemorrhageis ~ between 0.2-1%.
Almost all intracranial hemorrhages occur at platelet counts below /mm3, and generally below /mm3.
Risk factors : head trauma and exposure to antiplatelet drugs.

22. Most children with typical acute ITP recover completely within a few weeks without treatment and that there is no proof that therapy prevents intracranial hemorrhage.

23. American Society of Hematology
(ASH) recommends drug therapy for
children with platelet counts of less
than /mm3 with little or no purpura.

24. Treatment Watch & Wait strategy. Immunosupresive
- Corticosteroids (high, standard or low dose).
- Azathioprine
IVIG (high or low dose, 2 day or 1 day).
IV anti-D immunoglobulin in Rh(D) positive patients (high or low dose).
Splenectomi