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Samenvatting Hematologie 2 pathologische bloedingsneigingen
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Alle oorzaken van pathologische bloedingsneigingen worden besproken
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Hematologie 2: Pathologischebloedingsneigingen
A. Stoornissen primaire hemostase
o Erfelijk/verworven, niet aantoonbaar i/h labo
B. Stoornis bloedplaatjes - kwantitatief (=
trombocytopenie)
petechiën, mucosabloedingen mond/neus of na ingreep (onmiddellijk = primaire hemostase,
uitgesteld = secundaire heomstase)
o Pseudotrombocytopenie
1. EDTA onstolbaar gemaakt bloed
Aggregatie in vitro door slecht mengen (rechtsverschuiving PLT, linksverschuiving RBC)
Flagging door automaat
Citraatbuis afnemen + nieuwe telling
2. Medicatie
Inhibitor van plaatjesaggregatie
(pseudo)trombocytopenie
3. Congenitale ziekte - reuzetrombocyten
o Verminderde productie
1. Verminderde megakaryopoëse
- Beenmergfiltratie
- Cytostatica (bv. Chemotherapie)
- Ioniserende straling
- Verworven of congenitale amegakaryopoëse
- Aplastische anemie
2. Ineffectieve trombopoëse
- Vitamine B12 tekort
- Auto-immuun ziekte ↓ vit B12 opname
- Operatie (deel v/d maag of laatste deel dunne darm weggenomen)
- Medicatie
- ↓ maagzuurproductie
- Tekort aan ijzer/foliumzuur
3. Erfelijke trombocytopenie
- Gray-platelet syndroom
- Bernard-souliersyndroom
- Mutatiegeassocieerd syndroom
o Verhoogde afbraak/ verbruik
1. Immunologisch
- Geneesmiddelen bv sulfonamides nieuw epitoop Al
- Auto-immuun (auto-Al binden op trombocyten)
2. Niet-immunologisch (te hoog verbruik)
- TTP = trombotische trombocytopenische purpura
- DIS = diffusie intravasculaire stolling
- HUS = hemolytisch uremisch syndroom
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