Scanning electron microscope image of a red blood

cell (left), platelet (center), and white blood cell

(right). Credit: NCI-Frederick
Jumlah Normal Thrombocyte dlm darah
>/=150.000 450.000 (600.000) / mm
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SEPINTAS MENGENAI TROMBOSIT
/ PLATELET
A
Cell darah yang biasa beredar di peripher
B
TROMBOSITOPENIA
Prof. dr. Rusdidjas, SpA(K) Prof. dr. Rafita Ramayati,SpA(K),
dr.Oke Rina Ramayani, SpA dan dr. Hendy Zulkarnain,SpA
MEU-FK UISU 04-05 Mei 2009
POKOK BAHASAN
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4
THROMBOCYTOPENIA
Reduction in platelet count below 150.000/mm
3
A smear of human perypheral blood, from :www.uoguelph.ca/zoology/devobio/210labs/ct2.html


MEU FK-UISU 4/5 [AKUT KRONIK] dan 5/5 2009 [Primer Sekunder]
POKOK BAHASAN:
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5
ETIOLOGY OF
THROMBOCYTOPENIA
A). Destructive Thrombocytopenia:
Immunologic (Terbanyak)
ITP
Thrombotic thrombocytopenic purpura
Drug induced
Post-tranfusion purpura
Autoimmune disease
Post-transplant
Hyperthyroidism
Lymphoproliferative disorders

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6
B). Nonimmunologic
Microangiopathic disease
Hemolytic anemia and thrombocytopenia
Hemolytic-uremic syndrome
C). Platelet Consumption/Destruction
DIC
Giant Hemangiomas
Cardiac (prosthetic heart valves, repair of intra
cardiac defect)
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IDIOPATHIC THROMBOCYTOPENIC
PURPURA ( ITP )
Acute ITP :
- resolve within 6 months /Sembuh dlm 6 bln
- usually occurs in children ages 2 to 4 years
/ Biasanya terjadi pd anak usia 2 4 tahun
SUB POKOK BAHASAN
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Chronic ITP :
- persistent thrombocytopenia > 6 months
- child < 1 year, or > 10 years of age
- may have an associated autoimmune
disease or immunodeficiency state

-Neonatal Alloimmune Thrombocytopenic
Purpura ( NATP )
SUB POKOK BAHASAN
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CLINICAL MANIFESTATIONS
Sudden onset of generalized petechiae & purpura
Bleeding from the gums and mucous membrane
( paticularly with platelet < 10.000 / mm
3
)

History of preceding viral infection 1 to 4 week
before
No hepatosplenomegaly
1% of cases develop intracranial hemmorrhage
Resolution within 6 months
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10










( From Cines DB et al, Immune Thrombocytopenic Purpura, In : N Engl J med 2002 ; 346 )
ptechiae
purpura
conjunctival
hemorrhage
HowellJolly
bodies = bulat
licin, sisa dari
inti Chromatin
dlm RBC
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LABORATORY FINDINGS
Low platelet count
Giant platelet
Hemoglobin maybe decreased if there have been
profuse bleeding
BMP : normal granulocytic & erythrocyte series
with characteristically normal or increased
numbers of megakaryocytes, some of the
megakaryocytes may appear to be immature
Platelet antibody (+)
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12
TREATMENT
Intravenous Immunoglobulin ( IVIG )
- Dose : 0,8 1 g / kg /day ; 1-2 days
- Expensive and time consuming to administer
- Adverse effect : headaches & vomitting suggestive of
aseptic meningitis
Prednison
- Dose : 1-4 mg / kg / 24 hours ; 2-3 week or until a rise in
platelet count > 20.000 / mm
3

IV anti D therapy
- Given to Rh positive individuals
- Dose : 50 mikrogram / kg
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13
Splenectomy
- The older children ( > 4 years ) with severe ITP
> 1 years ( chronic ITP )
- Life threatening hemorrhage ( intracranial
hemorrhage ), if the platelet count cannot
rapidly be corrected with tranfusion of platelets
and administration of IVIG and corticosteroids
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14
NEONATAL ALLOIMMUNE
THROMBOCYTOPENIA ( NATP )
Caused by the development of maternal antibodies
against antigens present on fetal platelets that are
shared with the father and recognized as foreign
by the maternal immune system
platelet equivalent of Rh disease of the
newborn
1 in 4000 5000 live births
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15
CLINICAL MANIFESTATIONS
Generalized petechiae & purpura within the first few
days after delivery
Normal maternal platelet count, moderate to severe
thrombocytopenia in the newborn
No maternal thrombocytopenia in the past
30 % severe NATP may develop intracranial
hemorrhage
Early jaundice occurs in 20 % of cases as a results of
resolution of intracranial or intraorgan hemorrhage
The thrombocytopenia is transient, lasting up to 3 to
6 weeks
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DIAGNOSIS
Checking for the presence of maternal
alloantibodies directed against the fathers platelets
Specific studies to identify the target alloantigen

DIFFERENTIAL DIAGNOSIS
Transplacental transfer of maternal antiplatelet
auto antibodies ( Maternal ITP )
Viral or bacterial infection
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TREATMENT
Transfusion with antigen negatife patelets
IVIG = IV IMMUNOGLOBULIN, ( 1 g / kg /24 hours,
1-2 doses until platelet
> 50.000 / mm
3
)

PREVENTION
IVIG 1 g / kg /week from midgestation until near
term
Delivery should be performed by cesarean
section

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