Diep veneuze trombose
Trombose formatie =Virchow triad= endotheelschade, statis/turbulentie, hypercoagulabiliteit (fam of
secundair).
Vaak onderste extremiteiten (90%). Oppervlakkige trombose in v. saphena. Diep in poplitea, femoralis
of iliacale vaten. Kunnen ook emboliseren. Pijn (bij dorsiflexie), oedeemvorming. Snelle
collateraalvorming, opgezette oppervlakkige venen,warmer. Asympt in 50% van de gevallen.
Risico: stase (hartfalen, trauma, chirurgie, zwangerschap, kraamperiode),
Complete occlusie kan leiden tot cyanotische verkleuring met hevig oedeem
AO/echo of Doppler
T/ anticoagulantia, (beginnend met heparine), compressietherapie,
Secundair kans op inflammatie en pulmonaire embolie.
Anemieen: verlaagd Hb
S/ moeheid, hoofdpijn, bleek, angina, palpatie, tachycardie.
Geelzucht in het geval van hemolytische anemie
AO/ lab, beenmergonderzoek (verdenking maligniteit)
Hemophilie
Coagulatie stoornis.
A: VIII:C is verminderd. vWF is normaal.
Prevalentie 1:5000 (man), X linked, Vrouwen kunnen alleen drager zijn.
Klinische presentatie afhankelijk van hoeveelheid factor VIII:C.
Hoeveelheid factor<1%= frequente spontane bloedingen, haemarthose wat leidt tot deformiteit,
bloedingen in spieren (dus geen i.m. injectie)
1-5%= ernstige bloedingen na trauma, spontane bloeding
>5%= bloedingen na trauma/chirurgie.
Doodsoorzaak vaak cerebrale bloeding.
Lab: BT normaal, PT normaal, APTT verhoogd, VIII:C verlaagd, vWF normaal.
T/ recombinant factor VIII i.v. Halfwaardetijd is 12u, daarom twee maal daags gegeven.
Complicatie: 10% patiënten heeft antistoffen tegen VIII:C
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