Diseases Of The Blood

Disorders of the blood may manifest themselves as 'stroke-like' syndromes. Examination of the peripheral blood film is an important investigation in cerebrovascular disease. Where indicated, more extensive haematological investigation is necessary.

DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

A consequence of:

Sepsis Acute intravascular A bleeding tendency with

Pregnancy results in coagulation leading to haemorrhage into skin and

Malignancy -Consuming platelets -organs including the

Immune reactions and clotting factor NERVOUS SYSTEM.

Neurological involvement - a diffuse fluctuating encephalopathy, subarachnoid or subdural haemorrhage.

Diagnosis confirmed by - low platelet count - prolonged prothrombin time, elevated fibrin degradation products and reduced fibrinogen levels.

Treatment

Heparin. Fresh frozen plasma/vitamin K. Treatment of underlying cause. HAEMOGLOBINOPATHIES

These are genetically determined disorders in which abnormal haemoglobin is present in red blood cells. Sickle cell disease

This disorder is common in Negro populations and also occurs sporadically throughout the Mediterranean and Middle East region.

The patient is of small stature, usually with chronic leg ulcers, cardiomegaly and hcpatosplenomegaly. When arterial oxygen saturation is reduced, 'sickling' will occur, manifested clinically by abdominal pain/bone pain.

Neurological involvement - hemiparesis, optic atrophy, subarachnoid haemorrhage.

Diagnosis is confirmed in vitro by the 'sickling' of cells when 02 tension is reduced and by haemoglobin electrophoresis.

Treatment

Analgesics for pain

02 therapy, or hyperbaric 02.

exchange transfusion should be carried out for those with a severe or progressive deficit. / i

Sickle cells rbc

ANTIPHOSPHOLIPID ANTIBODIES

These IgB or IgM antibodies prolong prothrombin time and appear to be associated with thrombotic stroke. There remains uncertainty as to whether they are caused or represent a transient non-specific 'acute phase' reaction to illness. Such antibodies can be found in patients with systemic lupus erythematosus.

ANTITHROMBIN III, PROTEIN C and PROTEIN S DEFICIENCY

Deficiency of any of these circulating antithrombotic fibrinolytic agents can result in deep venous thrombosis, pulmanary embolism or thrombotic stroke.

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