KELAINAN TROMBOSIT

Oleh : dr. Diah Hermayanti, SpPK

FUNGSI TROMBOSIT :
– Menutup luka

gumpalan trombosit (pada tempat kerusakan pembuluh darah)

– Membuat faktor pembekuan

(faktor trombosit dan trombostenin untuk
memperkuat gumpalan trombosit di samping fibrin)

– Mengeluarkan serotonin
(untuk kontraksi pembuluh darah) dan
ADP (untuk mempercepat pembentukan gumpalan trombosit)
 GANGGUAN TROMBOSIT

KUANTITAS : KUALITAS :
 Jumlah turun (trombositopati) :
(trombositopenia) :  Primer
- produksi <<  Sekunder
- usia <; destruksi >
- pooling >> Fungsi yg terganggu :
(di Limpa)  Adesi
 Jumlah meningkat  Release
(trombositosis)  Agregasi
 Koagulasi
• Jumlah trombosit < 100.000/mm3 
petekia,
ekimosis ,dan
perdarahan abnormal lain

• Jumlah trombosit < 20.000/mm3 

hematemesia,
hematuria, dan
melena
TROMBOSITOPENIA Jumlah trombosit <

Hipersplenisme,
TTP
Penurunan masa DIC
hidup Sepsis
Trombositopenia imun

Mieloptisis
Penurunan Kelainan – kelainan sumsum
produksi tulang primer.
Infeksi
Obat - obat

Produksi yg
Proses – proses megaloblastik
tidak efektif
 KELAINAN FUNGSI TROMBOSIT HEREDITER

Kelainan Laboratorium

Kelainan adhesi
von Willebrand synd vWF, Platelet aggregation
Bernard-Soulier synd vWF, Platelet aggregation
Collagen disorders BT, normal platelet aggregation
Kelainan agregasi
Glansmann’s thrombasthenia BT, platelet aggregation, GP IIB-IIIA
Afibrinogenemia BT, platelet aggregation, fibrinogen
dll
 KELAINAN TROMBOSIT DIDAPAT
diah

(mengganggu fungsi trombosit)

Obat (aspirin, indometasin, ibuprofen, penisilin)

Antibodi trombosit
Penyakit ginjal
Myeloproliferative disorders
Myeloma
Fibrinolysis
Macromolecules
Fibrin split product
Monoclonal proteins
In vivo release
hypothyroidism
 diah
GANGGUAN TROMBOSIS

HEREDITER

Sistem Kelainan

Serine protease inhibitor Defisiensi Antitrombin III

(SERPINS) Def. Heparin kofaktor II

Sistem fibrinolitik Def. Protein C heterozygous

Def. Protein C homozygous
Def. Protein S heterozygous

Trombosit Hyperactive platelet synd

Miscellaneous dll
 Gangguan Trombotik Didapat

Kondisi sistemik : Kelainan hemostatik :

Atherosclerotic vascular disease Lupus anticoagulant

diabetes mellitus DIC
malignat neoplasma Thrombotic thrombocyto-
myeloproliferative disorders penic purpura
paroxismal nocturnal hemoglobinuria Hemolytic-uremic synd
estrogen & oral contraceptive Snake venoms
Pregnancy Coagulation factor-
venous stasis concentrates
nephrotic syndrome
hyperlipidemia
artificial vascular prostheses
hyperviscosity
 16

DISSEMINATED INTRAVASCULAR COAGULATION

diah
(DIC)
INITIATING STIMULUS

ACTIVATION ACTIVATION

THROMBIN PLASMIN

IBRIN PLATELET FACTOR FIBRINOLYS

ORMATION ACTIVATION CONSUMPTION

MICROVASCULAR HEMORRHAGE
THROMBOSIS

FIBRINOGEN PLATELET
DEPLETION DEPLETION

Brandt 1999
HEMORRHAGE
 DIC STIMULATOR :

1.Tissue factor coagulants :

trauma
hemolysis
carcinoma

2.Factor producing platelet aggregation :

septicemia
uremia
immune complexes

3.Endothelial damage :
burn
vasculitis
 PEMERIKSAAN LABORATORIUM

TES SKRINING :

 Jumlah & morfologi menilai primary

trombosit hemostatic plug
 Bleeding time

TES KHUSUS :
 Fungsi trombosit
adesi
sekresi
agregasi
 19

TES SKRINING PRIMARY HEMOSTATIC

diah PLUG
(TROMBOSIT-VASKULER )

Tujuan : menentukan kelainan trombosit / vaskuler

TROMBOSIT :
o morfologi
o jumlah
o fungsi

Capillary resistance test (Rumple-Leed test)

Bleeding time (Ivy ; Duke)

 20

RUMPLE – LEEDE TESTdiah

(Capillary resistance test)

VOLAR
(dibaca 15 menit setelah
Systole Tekanan dilepas)

HASIL :
(-) : jumlah ptekiae < 10
10-20 : meragukan
Diastole
(+) : > 20
5 minutes
(± 100 mmHg) POSITIF :
1.Trombositopenia
2.Gangguan vaskuler
3.Gangguan fungsi trombosit
 21

BLEEDING TIME / BT
diah

(waktu perdarahan)
BT menilai Pembentukan hemostatic plug

1. Kelainan trombosit
2. Kelainan vaskuler

Normal (Duke) : 1-3 menit

Memanjang :
1.Kelainan konstriksi vaskuler
2.Trombositopenia
3.Gangguan adhesi trombosit
4.Gangguan pelepasan ADP trombosit
5.Gangguan aggregasi trombosit
6.Gangguan avaibilitas PF3
 22

Bleeding Time diah

Volar
Cuping
telinga 40 mmHg
Cara Duke Cara Ivy
Normal Normal
1-3 menit 1-7 menit

2 Kertas
1½ 2½ saring
1 3
½

Start Start Bleeding time

Normal Abnormal
menilai :
(memanjang)
Dacie et al. 1975, Hirsh et al. 1979, Sirridge et al. 1983
 CK
LU
OD
GO