Thrombotic microangiopathies - 修訂歷史

Guhjy在2018年3月27日 (二) 04:37

Guhjy — Tue, 27 Mar 2018 04:37:08 GMT

←上一修訂		在2018年3月27日 (二) 04:37所做的修訂版本
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	*Interlobular artery, arterioles, glomerular capillaries: microthrombi, AKI		*Interlobular artery, arterioles, glomerular capillaries: microthrombi, AKI
	*DD: DIC, SLE, cancer		*DD: DIC, SLE, cancer
		+	*TTP and HUS: ADAMTS13 metalloprotease (which cleaves von Willebrand's factor) deficiency, hypocomplementemia
		+	*TTP (thrombotic thrombocytopenic purpura)
		+	**Familial, acquired, sporadic
		+	**Rx: Plasmapheresis, Rituximab (CD20 Ab to deplete B cell), steroids
		+	*HUS (hemolytic-uremic syndrome):
		+	**(esp. children) Shiga toxin [verotoxin] with enterohemorrhagic diarrhea (STEC: E. coli O157:H7, rarely Shigella), pneumococcus (rare), supportive Rx (no antibiotics, no anti-diarrhea Rx), dialysis prn.
		+	**(children or adults) Atypical HUS (complement activation): very rare, genetic or acquired, no diarrhea, normal or partial def. ADAMTS13
		+	**Rx: Plasmapheresis (not for typical STEC HUS), eculizumab (C5 Ab) for atypical HUS, (splenectomy)

Guhjy在2018年3月27日 (二) 04:35

Guhjy — Tue, 27 Mar 2018 04:35:55 GMT

←上一修訂		在2018年3月27日 (二) 04:35所做的修訂版本
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-	*~~Risk factors~~	+	*HUS/TTP, antiphospholipid syndrome, malignant HT., systemic sclerosis (renal crisis), HIV, pregnancy (preeclampsia, HELLP: hemolysis, elevated liver enzymes, low platelet count), hematopoietic stem cell transplantation
-	**Pregnancy, ~~pills~~, ~~quinine~~, ~~RT p'ts given OKT3 for rejection~~, ~~calcineurin inhibitors~~ (~~cyclosporine~~, ~~tacrolimus)~~, ~~antiplatelets (ticlopidine and clopidogrel~~), ~~HIV~~	+	*Pentad: thrombocytopenic purpura, intravascular hemolytic anemia (fragmented RBCs), fever, + AKI (HUS), + neurol. dis. (TTP)
-	*~~Clinical features~~	+	*Drugs: mitomycin, gemcitabine, VEGF inh., anti-rejection (calcineurin inhibitors, OKT3), pills, antiplatelets (ticlopidine, clopidogrel, prasugrel), quinine
-	**Thrombocytopenic purpura, hemolytic anemia, fever, ~~renal failure~~ (~~esp.~~ HUS), ~~neurologic disturbances (esp~~. ~~TTP)~~	+	*PT, aPTT: normal
-	*Pathology	+	*Interlobular artery, arterioles, glomerular capillaries: microthrombi, AKI
-	**Endotheliosis with fibrin thrombi	+	*DD: DIC, SLE, cancer
-	*1st classification	+
-	**Thrombotic thrombocytopenic purpura (TTP)	+
-	**[[Hemolytic-~~uremic syndrome~~ (~~HUS~~)]]	+
-	*2nd classification	+
-	**Adult HUS/TTP	+
-	***Familial: ADAMTS13 metalloprotease (~~that cleaves large multimers of von Willebrand's factor~~) ~~deficiency~~	+
-	***Sporadic	+
-	****Some p'ts have antibody to ADAMTS13 or thrombospondin receptor on endothelial cells	+
-	****Some p'ts have plasminogen-activator inhibitor 1 ↑	+
-	**Childhood HUS	+
-	***''Escherichia coli O157:~~H7'' (occasionally Shigella dysenteriae) causing enterohemorrhagic diarrhea~~	+
-	*Treatment	+
-	**Daily [[plasmapheresis]]	+
-	**Patients with childhood HUS from infectious diarrhea are ''not given antibiotics'', ~~as antibiotics are thought to accelerate the release of the toxin and the diarrhea is usually self-limited.~~	+

Guhjy在2018年3月27日 (二) 01:58

Guhjy — Tue, 27 Mar 2018 01:58:52 GMT

←上一修訂		在2018年3月27日 (二) 01:58所做的修訂版本
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	*Risk factors		*Risk factors
-	**Pregnancy, pills, quinine, RT p'ts given ~OKT3 for rejection, calcineurin inhibitors (cyclosporine, tacrolimus), antiplatelets (ticlopidine and clopidogrel), HIV	+	**Pregnancy, pills, quinine, RT p'ts given OKT3 for rejection, calcineurin inhibitors (cyclosporine, tacrolimus), antiplatelets (ticlopidine and clopidogrel), HIV
	*Clinical features		*Clinical features
	**Thrombocytopenic purpura, hemolytic anemia, fever, renal failure (esp. HUS), neurologic disturbances (esp. TTP)		**Thrombocytopenic purpura, hemolytic anemia, fever, renal failure (esp. HUS), neurologic disturbances (esp. TTP)

Guhjy在2018年3月27日 (二) 01:58

Guhjy — Tue, 27 Mar 2018 01:58:33 GMT

←上一修訂		在2018年3月27日 (二) 01:58所做的修訂版本
第1行：		第1行：
	*Risk factors		*Risk factors
-	**Pregnancy, pills, quinine, RT ~~p’ts~~ given ~OKT3 for rejection, calcineurin inhibitors (cyclosporine, tacrolimus), antiplatelets (ticlopidine and clopidogrel), HIV	+	**Pregnancy, pills, quinine, RT p'ts given ~OKT3 for rejection, calcineurin inhibitors (cyclosporine, tacrolimus), antiplatelets (ticlopidine and clopidogrel), HIV
	*Clinical features		*Clinical features
	**Thrombocytopenic purpura, hemolytic anemia, fever, renal failure (esp. HUS), neurologic disturbances (esp. TTP)		**Thrombocytopenic purpura, hemolytic anemia, fever, renal failure (esp. HUS), neurologic disturbances (esp. TTP)
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	*2nd classification		*2nd classification
	**Adult HUS/TTP		**Adult HUS/TTP
-	***Familial: ~ADAMTS13 metalloprotease (that cleaves large multimers of von Willebrand's factor) deficiency	+	***Familial: ADAMTS13 metalloprotease (that cleaves large multimers of von Willebrand's factor) deficiency
	***Sporadic		***Sporadic
-	****Some p'ts have antibody to ~ADAMTS13 or thrombospondin receptor on endothelial cells	+	****Some p'ts have antibody to ADAMTS13 or thrombospondin receptor on endothelial cells
	****Some p'ts have plasminogen-activator inhibitor 1 ↑		****Some p'ts have plasminogen-activator inhibitor 1 ↑
	**Childhood HUS		**Childhood HUS

Guhjy在2018年3月27日 (二) 01:58

Guhjy — Tue, 27 Mar 2018 01:58:01 GMT

←上一修訂		在2018年3月27日 (二) 01:58所做的修訂版本
第18行：		第18行：
	*Treatment		*Treatment
	**Daily [[plasmapheresis]]		**Daily [[plasmapheresis]]
-	**Patients with childhood HUS from infectious diarrhea are ''not given antibiotics'', as	+	**Patients with childhood HUS from infectious diarrhea are ''not given antibiotics'', as antibiotics are thought to accelerate the release of the toxin and the diarrhea is usually self-limited.
-	antibiotics are thought to accelerate the release of the toxin and the diarrhea is usually self-limited	+

Guhjy在2018年3月13日 (二) 09:44

Guhjy — Tue, 13 Mar 2018 09:44:11 GMT

←上一修訂		在2018年3月13日 (二) 09:44所做的修訂版本
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	***''Escherichia coli O157:H7'' (occasionally Shigella dysenteriae) causing enterohemorrhagic diarrhea		***''Escherichia coli O157:H7'' (occasionally Shigella dysenteriae) causing enterohemorrhagic diarrhea
	*Treatment		*Treatment
-	**Daily [[~~Plasmapheresis~~]]	+	**Daily [[plasmapheresis]]
	**Patients with childhood HUS from infectious diarrhea are ''not given antibiotics'', as		**Patients with childhood HUS from infectious diarrhea are ''not given antibiotics'', as
	antibiotics are thought to accelerate the release of the toxin and the diarrhea is usually self-limited		antibiotics are thought to accelerate the release of the toxin and the diarrhea is usually self-limited

Guhjy: 新頁面: *Risk factors **Pregnancy, pills, quinine, RT p’ts given ~OKT3 for rejection, calcineurin inhibitors (cyclosporine, tacrolimus), antiplatelets (ticlopidine and clopidogrel), HIV *Clinic...

Guhjy — Tue, 13 Mar 2018 09:43:54 GMT

新頁面: *Risk factors **Pregnancy, pills, quinine, RT p’ts given ~OKT3 for rejection, calcineurin inhibitors (cyclosporine, tacrolimus), antiplatelets (ticlopidine and clopidogrel), HIV *Clinic...

新頁面

*Risk factors
**Pregnancy, pills, quinine, RT p’ts given ~OKT3 for rejection, calcineurin inhibitors (cyclosporine, tacrolimus), antiplatelets (ticlopidine and clopidogrel), HIV
*Clinical features
**Thrombocytopenic purpura, hemolytic anemia, fever, renal failure (esp. HUS), neurologic disturbances (esp. TTP)
*Pathology
**Endotheliosis with fibrin thrombi
*1st classification
**Thrombotic thrombocytopenic purpura (TTP)
**[[Hemolytic-uremic syndrome (HUS)]]
*2nd classification
**Adult HUS/TTP
***Familial: ~ADAMTS13 metalloprotease (that cleaves large multimers of von Willebrand's factor) deficiency
***Sporadic
****Some p'ts have antibody to ~ADAMTS13 or thrombospondin receptor on endothelial cells
****Some p'ts have plasminogen-activator inhibitor 1 ↑
**Childhood HUS
***''Escherichia coli O157:H7'' (occasionally Shigella dysenteriae) causing enterohemorrhagic diarrhea
*Treatment
**Daily [[Plasmapheresis]]
**Patients with childhood HUS from infectious diarrhea are ''not given antibiotics'', as
antibiotics are thought to accelerate the release of the toxin and the diarrhea is usually self-limited