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GANGGUAN HEMATOLOGI PADA

PENYAKIT GAGAL GINJAL KRONIS

Dairion Gatot, Savita Handayani, Soegiarto Gani

Divii He!ato"ogi#On$o"ogi Medi$ 

De%arte!en I"!& Penya$it Da"a! 'K#USU(RS H)Ada! Ma"i$ 

Medan *+*

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DAMPAK TERHADAP HEMATOLOGI

1. ANEMIA

2. PERDARAHAN3. TROMBOSIS

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ANEMIA

* PATOGENESIS :

- DEF. ERITROPOIETIN- DEPRESI SST

- HEMOLISIS

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DE') ERITROPOIETIN

  *  GINJAL MEMPRODUKSI ERITROPOIETIN

  * PENYAKIT GINJAL→  ERITROPOIETIN ↓

  * ERITROPOIETIN MERANGSANG

  * ERITROPOIESIS YAITU PEMBENTUKAN

  SEL DARAH MERAH

  * PEMBERIAN ERITROPOIETIN→  HB↑ 

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HU-UNGAN GANGGUAN 'UNGSI

GINJAL DAN ANEMIA

1. CCT ↓  →  HB ↓

2. UREUM↑

 →

  HB↓

3. GLOMERULAR FILTRATION RATE ↓ → HB ↓

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DEPRESI SUMSUM TULANG

1. ZAT TOKSIS

2. HIPERPARATIROIDISM SEKUNDER 

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.AT TOKSIS

* PASIEN YG DIBERIKAN ERITROPOIETIN

ADAKALANYA TDK DIIKUTI KENAIKANHB DAN BARU HB ↑ SESUDAH DIIKUTI

DIALISIS

* ZAT TOKSIS : POLYAMINE  SPERMINE

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HIPERPARATIROIDISM

PASIEN GGK DENGAN

HIPERPARATIROIDISM SESUDAH

MENJALANI PARATIROIDEKTOMI→ PADA 4-!" KASUS HB ↑

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HEMOLISIS

* UMUR SDM ↓ PADA GGK #2 " KASUS$

* TRASFUSI SDM PD GGK UMURNYA↓ 

DIBANDINGKAN DGN YG BUKAN GGK 

* PATOGENESIS : ZAT TOKSIS SEPERTI

GUANIDIN→ GANGGUAN JALUR

PENTOSA SDM

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PENGO-ATAN

* ERITROPOIETIN

* TRANSPLANTASI

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HEMOSTASIS PADA

GAGAL GINJAL KRONIK 

* PERDARAHAN  ! " GGK MENGALAMI :

- PURPURA  - MENORRAGIA  - EPISTAKSIS

- PERDARAHAN SALURAN CERNA 

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PATO'ISIOLOGI

* INTERAKSI TROMBOSIT DANP.DARAH TERGANGGU → MASAPERDARAHAN ↑

* PENYEBAB : GUANIDINO SUCCINICACID #GSA$ ↑

* GSA→ NITRIK OKSID #NO$ ↑- ADHESI- AGGREGASI

- ESTROGEN → MENGHAMBAT PRODUKSI NO- ANEMIA→ INTERAKSI P.DARAH- TROMBOSIT

TERGANGGU

TROMBOSIT ↓

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PENGO-ATAN

* DIALISIS → MEMPERPENDEK MASA PERDARAHAN

* ESTROGEN

* %ASOPRESIN #DDAP$

* MENAIKKAN HB

* KRIOPRESIPITAT