Post on 18-Feb-2018
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LAPORAN KASUS IMUNOLOGIK TROMBOSITOPENIK
PURPURA (ITP)
Pembimbing :dr. Rosida S.P!
!is"s"n o#e$ :As%i&a'a
*+,
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Iden%i%as asien
Nama : Nn. Anis -i%ria
Um"r : %$n
enis &e#amin : Perem"an S"&" Bangsa : Mad"ra
A#ama% : So/a$
Pe&er0aan : Pe#a0ar MRS : *1+12+3
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ANAMNESIS
Ke#"$an "%ama :
erdara$an er4aginam
Ri'a5a% en5a&i% se&arang :6 da%ang &e IG! dengan &e#"$anerdara$an er4aginam ban5a& se#ama 7$ari8 se$ari gan%i emba#"% 96. Ser%a
erdara$an g"si8 memar &ebir"an di ba'a$&"#i%8 ramb"% ron%o&. BAB dan BAK norma#.
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Ri'a5a% en5a&i% da$"#" :
Tida& erna$ sa&i% seer%i ini sebe#"n5a.A#ergi (1)8 Asma (1)8 ;T (1)8 !M (1).
Ri'a5a% en5a&i% &e#"arga :
Tida& ada sa&i% seer%i ini di &e#"arga.
Ri'a5a% engoba%an :Be#"m erna$ beroba% sama se&a#i.
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Pemeri&saan -isi&
Pemeri&saan "m"m
Keadaan "m"m : %ama& #ema$
Kesadaran : /omos men%is (838<) =i%a# sign :
T! : 2+>7+ mm$g RR : 2+6>meni%
Nadi : 776>meni% Tem: 7?
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S%a%"s #o&a#isasi organ KEPALA :Ben%"& : B"#a%8 sime%ris
Ramb"% : ;i%am8 #"r"s8 ron%o&
Ma%a : &on0"ng%i4a anemis (@>@)
S&e#ra i&%er"s (1>1)8 "i# iso&orRee& /a$a5a (@>@)
;id"ng : se&re% (1>1)8 ba" (1>1)8 erdara$an (1>1)
Te#inga : se&re% (1>1)8 ba" (1>1)8 erdara$an (1>1)
M"#"% : sianosis8 erdara$an g"si (@)
LE;ER :
Pembesaran KGB (1)8 Pembesaran %5roid (1)
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T;ORA :
P"#mo
I : Pergera&an dada sime%ris (@>@)8 s/ar (1>1)
P : Bagian dada %er%ingga# (1)
P : Sonor ada &ed"a #aang ar"
A : =esi&"#er (@>@)8 ron&$i (1>1)8 '$eeCing (1>1)
?or
I : I/%"s ?ordis %ida& %er#i$a%
P : I/%"s /ordis %ida& %eraba
P :ba%as 0an%"ng &anan D I?S = aras%erna#isde&s%ra
ba%as 0an%"ng &iri D I?S I= mid&#a4i&"#arissinis%ra
A : S8 S2 %"ngga#8 reg"#er8 m"rm"r (1)8 ga##o1
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Abdomen
I : be&as #"&a (1)8 da#am ba%as norma#
P : N5eri %e&an (1)8 %ida& %eraba ben0o#an8 $ear%ida& %eraba8 #ien %ida& %eraba
P : Timani
A : Bising "s"s (@)
Urogeni%a#
!a#am ba%as norma#
E&s%remi%as
S"erior : a&ra# $anga% (@>@)8 odema (1>1)
Inerior : a&ra# $anga% (@>@)8 odema (1>1)
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Pemeri&saan en"n0ang JENIS HASIL NORMAL
FB? .+ +e>"L .*+1+.
NEU .3 7*.< .<1<.,<
,.1*.*
LHM 27 *.+ .+,12.,,
.7.+17.
MONO 32 .*7 2+1*,+ .+12.*
EOS + ++1+ <++1*.+
BASO +< . +.++1+7+ +8++1*+
RB? .77 +e<>"L .<+1.<,
;GB +.3 g>L +.71.2
;?T +. *.*13.*
M?= *7. L 7.1,<.+M?; 2*. Pg 2*.+1.2
M?;? ., g>dL .713.
R!F *. .31.3
PTL *.2 +e>"L 331<<
MP= 3.2 L <.,+1+.<
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tgl S O A P
7 o&%2+3
KU #ema$8 "/a%8anemis(@)8 g"si berdara$ (@)8erdara$an er4aginam(@)8 mimisan (@) 8"sing (@)8m"a# (@).
T! : ++><+mm$gNadi : 7+6>meni%RR : 2+6>meni%
Tem : <83 ?
Anemia8S. ITP
Pesan T? +&an%ong8 er#"%rans" T?
Tran"si PR?smai ;b +
In0.Me%$i#re%niso#on 623 mg
, o&%2+3
KU #ema$8 "/a%8anemis(@)8 g"si berdara$ (@)8erdara$an er4aginam
(@)8 mimisan (1)8 "sing(@)8demam(@)8 m"a#(@)8 BAB (1)8 BAK$ema%"ri (@)
T! : ++><+mm$gNadi : 76>meni%RR : 2+6>meni%
Tem : *87 ?
Anemia8S. ITP
In. AseringNe"robion 26Asam o#a% 6
In0.Me%$i#re%niso#on 623
Tran"si P?R 2&an%ong smai;b +?e& !L @ LE!
UL8 ANA Tes%2+ o&%2+3
KU #ema$8 "/a%8anemis(@)8 g"si berdara$ (@)8erdara$an er4aginam(@)8 mimisan (1)8 "sing(@)8 demam (@)8 m"a#(1)8saria'an (@)8 BAB (1)8
BAK $ema%"ri (@)8 nas"ma&an men"r"n.
T! : ,+><+mm$gNadi : 7+6>meni%RR : 2+6>meni%
Tem : * ?
Anemia8S. ITP
?a# ges 6In0.Me%$i#redniso#on 623
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tgl S O A P
2o&%2+3
KU #ema$8 "/a%8anemis (@)8g"si berdara$ (@)8erdara$an er4aginam (@)8
mimisan (@) 8 "sing(@)8saria'an (@)8m"a#(1)8BAB (1)8 BAK $ema%"ri (@)8nas" ma&an men"r"n.
T!:,+><+mm$gNadi :
726>meni%RR : 2+6>meni%
Tem : <8 ?
Anemia8S. ITP
T6 #an0"%
22o&%
2+3
KU #ema$8 "/a%8anemis (@)8g"si berdara$ (@)8
erdara$an er4aginam (@)8mimisan (1)8demam (@)"sing (@)8m"a# (1)8saria'an(@)8 BAB (1)8 BAK $ema%"ri(@)8 nas" ma&an men"r"n.
T! :+>,+mm$g
Nadi :7+6>meni%RR : 2+6>meni%
Tem : 7 ?
Anemia8S. ITP
T6 #an0"%Rani%idin 26
2
o&%2+3
KU #ema$8 "/a%8anemis (@)8
g"si berdara$ (@)8erdara$an er4aginam (@)sedi&i%8 "sing (@)8saria'an(@)8 BAB (1)8 BAK $ema%"ri(@)8 nas" ma&an men"r"n.
T! :
+>,+mm$gNadi :7+6>meni%RR : 2+6>meni%
Tem : <87 ?
Anemia8
S. ITP
PRO RUUK
7/23/2019 ITP interna
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2 o&%2+3
KU #ema$8 "/a%8anemis (1)8g"si berdara$ (1)8 erdara$aner4aginam (@) sedi&i%8mimisan (1)8 "sing (1)8m"a#(1)8saria'an (@)8 BAB (1)8 BAK$ema%"ri (1)8 nas" ma&anmen"r"n.
T! : +>,+mm$gNadi : 726>meni%RR : 2+6>meni%
Tem : <87 ?
Anemia8S. ITP
Tran"si T?+ &an%ong#an0"%Me%$i#renidso#on
23 o&%2+3
KU #ema$8 "/a%8anemis (1)8g"si berdara$ (1)8 erdara$aner4aginam (@) sedi&i%8mimisan (1)8 "sing (1)8m"a#(1)8saria'an (@)8 ba%"&(@)8sesa&(@)8 s"#i% %id"r8 BAB
(1)8 BAK $ema%"ri (1)8 nas"ma&an men"r"n8 a&ra#dingin.
T! : ++>*+mm$gNadi : 776>meni%RR : 2+6>meni%
Tem : <82 ? T$ora6 : ron&ibasa$ $a#"s
ITPS. Pne"monia
T6 #an0"%
2< o&%2+3
KU #ema$8 "/a%8 demam(@)ba%"&(@)8 sesa&(@)8 s"#i%%id"r.
T! : ++><+mm$gNadi : 726>meni%RR : 2+6>meni%
Tem : <82 ?
T$ora&: ron&ibasa$ $a#"s
ITPS. Pne"monia
In. PJ3++>$ariMP s%oGan%i MP
6< mgIn0. Lasi6In0.?e%riason26In0. Le4o6*3+
In0. Rani%idin26
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TINAUAN PUSTAKA
A. Idioa%i& %rombosi%oeni& "r"ra (ITP)
. !eenisi
P"r"ra %rombosi%oeni& idioa%i& (PTI)ada#a$ en5a&i% "r"ra %rombosi%oeni&5ang en5ebabn5a %ida& di&e%a$"i8di%andai dengan %romboeni a&iba%
des%r"&si %rombosi% 5ang mening&a%85ang &em"dian di&e%a$"i di sebab&ano#e$ &arena rosesim"no#ogi&.
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Me&anisme %rombooesis
Pemb"a%an %rombosi%8 %er0adi di da#ams"ms"m %"#ang di mana se# ind"&berdierensiasi men0adi mega&ar5osi%es.Progeni%or mega&ar5osi%es a&$irn5aberdierensiasi men0adi ma%ang danme#eas&an %rombosi%. "m#a$ %rombsosi%
di da#am sir&"#asi a&an men/aai ang&as%abi# aabi#a rod"&si %rombosi%seimabang dengan des%r"&si %rombosi%.
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PATOGENESIS
Anti bodi IgG yang ditemukan padamembran trombosit akan mengakibatkan
gangguan agregasi trmbosit danmeningkatkan pembuangan serta penghancuran trombosit oleh sistemmakrofag sehingga fungsi trombosit
dapat berubah (trombositopati) melaluiberbagai cara yang mengakibatkan
perdarahan yang lama.
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Ge0a#a K#inis
Ge0a#a biasan5a er#a$an1#a$an denganri'a5a% m"da$ berdara$ dengan
%ra"ma ma""n %ana %ra"ma. Ben%"&erdara$an ada ITP ada#a$ "r"raada &"#i% a%a" m"&osa ($id"ng8 g"si8sa#"ran ma&anan8 %ra&%"s "rogeni%a#).
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!iagnosis
. Perdara$an a%a" "r"ra ada #ebi$ dari sa%" #o&asi
2. Tida& ada embesaran #ima
. Terdaa% %romboenia diba'a$ 3+.+++>/mm ada
emeri&saan dara$ %ei. Pada emeri&saan asirasi s"ms"m %"#ang 0"m#a$
mega&ariosi% norma# a%a" mening&a% eri%rooisisser%a #e&ooisis norma#
3. M"ng&in di%em"&an an%i#a%e#e% an%ibod5 osi%i <. Tida& ada en5a&i% #ain 5ang men5ebab&an
%romboeni misa#n5a oba%1oba%an8 sesis8 &oag"#asiin%ra4as&"#er disemina%a8 SLE8 #e&emia dan os%%rans"si
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!iagnosa banding
• Anemia a#as%i&
• SLE
• !;-
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Terai
Terai a'a# ITP (s%andar%)
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Prognosis
Pada enderi%a "sia m"da8 "m"mn5arognosisn5a #ebi$ bai&. Prognosis 0e#e&
ada ITP 5ang rera&%er %er$adaengoba%an s%eroid