Lndwdi1jdXN0b20tc2VhcmNoLWZpbHRlci1zdWJtaXRbZGF0YS10b29sc2V0LXZpZXdzLWN1c3RvbS1zZWFyY2gtc3VibWl0PSI1NTU2ZjdjMzc2MjIwYjEyNjY5MjU1MjRmODYxY2RmNCJdIHsgdGV4dC1hbGlnbjogbGVmdDsgfSAud3B2LWN1c3RvbS1zZWFyY2gtZmlsdGVyLXN1Ym1pdFtkYXRhLXRvb2xzZXQtdmlld3MtY3VzdG9tLXNlYXJjaC1zdWJtaXQ9IjU1NTZmN2MzNzYyMjBiMTI2NjkyNTUyNGY4NjFjZGY0Il0gLndwdi1zdWJtaXQtdHJpZ2dlciB7IGNvbG9yOiByZ2JhKCA1MiwgMTY0LCAyMDIsIDEgKTtiYWNrZ3JvdW5kLWNvbG9yOiByZ2JhKCAyNTUsIDI1NSwgMjU1LCAxICk7Ym9yZGVyLXJhZGl1czogMDsgfSAudGItY29udGFpbmVyIC50Yi1jb250YWluZXItaW5uZXJ7d2lkdGg6MTAwJTttYXJnaW46MCBhdXRvfSAud3AtYmxvY2stdG9vbHNldC1ibG9ja3MtY29udGFpbmVyLnRiLWNvbnRhaW5lcltkYXRhLXRvb2xzZXQtYmxvY2tzLWNvbnRhaW5lcj0iNmE0NDZiODhiMDZmNjI0YTE4ZjcyOTFiMGViMmYyNzkiXSB7IHBhZGRpbmc6IDI1cHg7IH0gLnRiLWdyaWQsLnRiLWdyaWQ+LmJsb2NrLWVkaXRvci1pbm5lci1ibG9ja3M+LmJsb2NrLWVkaXRvci1ibG9jay1saXN0X19sYXlvdXR7ZGlzcGxheTpncmlkO2dyaWQtcm93LWdhcDoyNXB4O2dyaWQtY29sdW1uLWdhcDoyNXB4fS50Yi1ncmlkLWl0ZW17YmFja2dyb3VuZDojZDM4YTAzO3BhZGRpbmc6MzBweH0udGItZ3JpZC1jb2x1bW57ZmxleC13cmFwOndyYXB9LnRiLWdyaWQtY29sdW1uPip7d2lkdGg6MTAwJX0udGItZ3JpZC1jb2x1bW4udGItZ3JpZC1hbGlnbi10b3B7d2lkdGg6MTAwJTtkaXNwbGF5OmZsZXg7YWxpZ24tY29udGVudDpmbGV4LXN0YXJ0fS50Yi1ncmlkLWNvbHVtbi50Yi1ncmlkLWFsaWduLWNlbnRlcnt3aWR0aDoxMDAlO2Rpc3BsYXk6ZmxleDthbGlnbi1jb250ZW50OmNlbnRlcn0udGItZ3JpZC1jb2x1bW4udGItZ3JpZC1hbGlnbi1ib3R0b217d2lkdGg6MTAwJTtkaXNwbGF5OmZsZXg7YWxpZ24tY29udGVudDpmbGV4LWVuZH0gLnRiLWdyaWQsLnRiLWdyaWQ+LmJsb2NrLWVkaXRvci1pbm5lci1ibG9ja3M+LmJsb2NrLWVkaXRvci1ibG9jay1saXN0X19sYXlvdXR7ZGlzcGxheTpncmlkO2dyaWQtcm93LWdhcDoyNXB4O2dyaWQtY29sdW1uLWdhcDoyNXB4fS50Yi1ncmlkLWl0ZW17YmFja2dyb3VuZDojZDM4YTAzO3BhZGRpbmc6MzBweH0udGItZ3JpZC1jb2x1bW57ZmxleC13cmFwOndyYXB9LnRiLWdyaWQtY29sdW1uPip7d2lkdGg6MTAwJX0udGItZ3JpZC1jb2x1bW4udGItZ3JpZC1hbGlnbi10b3B7d2lkdGg6MTAwJTtkaXNwbGF5OmZsZXg7YWxpZ24tY29udGVudDpmbGV4LXN0YXJ0fS50Yi1ncmlkLWNvbHVtbi50Yi1ncmlkLWFsaWduLWNlbnRlcnt3aWR0aDoxMDAlO2Rpc3BsYXk6ZmxleDthbGlnbi1jb250ZW50OmNlbnRlcn0udGItZ3JpZC1jb2x1bW4udGItZ3JpZC1hbGlnbi1ib3R0b217d2lkdGg6MTAwJTtkaXNwbGF5OmZsZXg7YWxpZ24tY29udGVudDpmbGV4LWVuZH0udGItY29udGFpbmVyIC50Yi1jb250YWluZXItaW5uZXJ7d2lkdGg6MTAwJTttYXJnaW46MCBhdXRvfSAud3AtYmxvY2stdG9vbHNldC1ibG9ja3MtY29udGFpbmVyLnRiLWNvbnRhaW5lcltkYXRhLXRvb2xzZXQtYmxvY2tzLWNvbnRhaW5lcj0iNWNkNDc2ZGY1NDFkZjE4NjBkY2RmOWQ3NGQ0NmM5YjUiXSB7IGJhY2tncm91bmQ6IHVybCgnaHR0cHM6Ly9zYXZlenphcmlqZXRrZS5vcmcvd3AtY29udGVudC91cGxvYWRzLzIwMjEvMTEvaGVhZGVyLWJhY2tncm91bmQuanBnJykgY2VudGVyIGNlbnRlciBuby1yZXBlYXQ7YmFja2dyb3VuZC1zaXplOmNvdmVyO3BhZGRpbmc6IDEyNXB4IDI1cHggMjVweCAyNXB4OyB9IC50Yi1jb250YWluZXIgLnRiLWNvbnRhaW5lci1pbm5lcnt3aWR0aDoxMDAlO21hcmdpbjowIGF1dG99IC53cC1ibG9jay10b29sc2V0LWJsb2Nrcy1jb250YWluZXIudGItY29udGFpbmVyW2RhdGEtdG9vbHNldC1ibG9ja3MtY29udGFpbmVyPSI0MTg0MWUxMWJjMmFhOTRjZDczYWE4Nzg3YTQ0NGE2MCJdIHsgcGFkZGluZzogMjBweDsgfSBAbWVkaWEgb25seSBzY3JlZW4gYW5kIChtYXgtd2lkdGg6IDEwMjRweCkgeyAudGItY29udGFpbmVyIC50Yi1jb250YWluZXItaW5uZXJ7d2lkdGg6MTAwJTttYXJnaW46MCBhdXRvfS50Yi1ncmlkLC50Yi1ncmlkPi5ibG9jay1lZGl0b3ItaW5uZXItYmxvY2tzPi5ibG9jay1lZGl0b3ItYmxvY2stbGlzdF9fbGF5b3V0e2Rpc3BsYXk6Z3JpZDtncmlkLXJvdy1nYXA6MjVweDtncmlkLWNvbHVtbi1nYXA6MjVweH0udGItZ3JpZC1pdGVte2JhY2tncm91bmQ6I2QzOGEwMztwYWRkaW5nOjMwcHh9LnRiLWdyaWQtY29sdW1ue2ZsZXgtd3JhcDp3cmFwfS50Yi1ncmlkLWNvbHVtbj4qe3dpZHRoOjEwMCV9LnRiLWdyaWQtY29sdW1uLnRiLWdyaWQtYWxpZ24tdG9we3dpZHRoOjEwMCU7ZGlzcGxheTpmbGV4O2FsaWduLWNvbnRlbnQ6ZmxleC1zdGFydH0udGItZ3JpZC1jb2x1bW4udGItZ3JpZC1hbGlnbi1jZW50ZXJ7d2lkdGg6MTAwJTtkaXNwbGF5OmZsZXg7YWxpZ24tY29udGVudDpjZW50ZXJ9LnRiLWdyaWQtY29sdW1uLnRiLWdyaWQtYWxpZ24tYm90dG9te3dpZHRoOjEwMCU7ZGlzcGxheTpmbGV4O2FsaWduLWNvbnRlbnQ6ZmxleC1lbmR9IC50Yi1ncmlkLC50Yi1ncmlkPi5ibG9jay1lZGl0b3ItaW5uZXItYmxvY2tzPi5ibG9jay1lZGl0b3ItYmxvY2stbGlzdF9fbGF5b3V0e2Rpc3BsYXk6Z3JpZDtncmlkLXJvdy1nYXA6MjVweDtncmlkLWNvbHVtbi1nYXA6MjVweH0udGItZ3JpZC1pdGVte2JhY2tncm91bmQ6I2QzOGEwMztwYWRkaW5nOjMwcHh9LnRiLWdyaWQtY29sdW1ue2ZsZXgtd3JhcDp3cmFwfS50Yi1ncmlkLWNvbHVtbj4qe3dpZHRoOjEwMCV9LnRiLWdyaWQtY29sdW1uLnRiLWdyaWQtYWxpZ24tdG9we3dpZHRoOjEwMCU7ZGlzcGxheTpmbGV4O2FsaWduLWNvbnRlbnQ6ZmxleC1zdGFydH0udGItZ3JpZC1jb2x1bW4udGItZ3JpZC1hbGlnbi1jZW50ZXJ7d2lkdGg6MTAwJTtkaXNwbGF5OmZsZXg7YWxpZ24tY29udGVudDpjZW50ZXJ9LnRiLWdyaWQtY29sdW1uLnRiLWdyaWQtYWxpZ24tYm90dG9te3dpZHRoOjEwMCU7ZGlzcGxheTpmbGV4O2FsaWduLWNvbnRlbnQ6ZmxleC1lbmR9LnRiLWNvbnRhaW5lciAudGItY29udGFpbmVyLWlubmVye3dpZHRoOjEwMCU7bWFyZ2luOjAgYXV0b30udGItY29udGFpbmVyIC50Yi1jb250YWluZXItaW5uZXJ7d2lkdGg6MTAwJTttYXJnaW46MCBhdXRvfSB9IEBtZWRpYSBvbmx5IHNjcmVlbiBhbmQgKG1heC13aWR0aDogNTk5cHgpIHsgLnRiLWNvbnRhaW5lciAudGItY29udGFpbmVyLWlubmVye3dpZHRoOjEwMCU7bWFyZ2luOjAgYXV0b30udGItZ3JpZCwudGItZ3JpZD4uYmxvY2stZWRpdG9yLWlubmVyLWJsb2Nrcz4uYmxvY2stZWRpdG9yLWJsb2NrLWxpc3RfX2xheW91dHtkaXNwbGF5OmdyaWQ7Z3JpZC1yb3ctZ2FwOjI1cHg7Z3JpZC1jb2x1bW4tZ2FwOjI1cHh9LnRiLWdyaWQtaXRlbXtiYWNrZ3JvdW5kOiNkMzhhMDM7cGFkZGluZzozMHB4fS50Yi1ncmlkLWNvbHVtbntmbGV4LXdyYXA6d3JhcH0udGItZ3JpZC1jb2x1bW4+Knt3aWR0aDoxMDAlfS50Yi1ncmlkLWNvbHVtbi50Yi1ncmlkLWFsaWduLXRvcHt3aWR0aDoxMDAlO2Rpc3BsYXk6ZmxleDthbGlnbi1jb250ZW50OmZsZXgtc3RhcnR9LnRiLWdyaWQtY29sdW1uLnRiLWdyaWQtYWxpZ24tY2VudGVye3dpZHRoOjEwMCU7ZGlzcGxheTpmbGV4O2FsaWduLWNvbnRlbnQ6Y2VudGVyfS50Yi1ncmlkLWNvbHVtbi50Yi1ncmlkLWFsaWduLWJvdHRvbXt3aWR0aDoxMDAlO2Rpc3BsYXk6ZmxleDthbGlnbi1jb250ZW50OmZsZXgtZW5kfSAudGItZ3JpZCwudGItZ3JpZD4uYmxvY2stZWRpdG9yLWlubmVyLWJsb2Nrcz4uYmxvY2stZWRpdG9yLWJsb2NrLWxpc3RfX2xheW91dHtkaXNwbGF5OmdyaWQ7Z3JpZC1yb3ctZ2FwOjI1cHg7Z3JpZC1jb2x1bW4tZ2FwOjI1cHh9LnRiLWdyaWQtaXRlbXtiYWNrZ3JvdW5kOiNkMzhhMDM7cGFkZGluZzozMHB4fS50Yi1ncmlkLWNvbHVtbntmbGV4LXdyYXA6d3JhcH0udGItZ3JpZC1jb2x1bW4+Knt3aWR0aDoxMDAlfS50Yi1ncmlkLWNvbHVtbi50Yi1ncmlkLWFsaWduLXRvcHt3aWR0aDoxMDAlO2Rpc3BsYXk6ZmxleDthbGlnbi1jb250ZW50OmZsZXgtc3RhcnR9LnRiLWdyaWQtY29sdW1uLnRiLWdyaWQtYWxpZ24tY2VudGVye3dpZHRoOjEwMCU7ZGlzcGxheTpmbGV4O2FsaWduLWNvbnRlbnQ6Y2VudGVyfS50Yi1ncmlkLWNvbHVtbi50Yi1ncmlkLWFsaWduLWJvdHRvbXt3aWR0aDoxMDAlO2Rpc3BsYXk6ZmxleDthbGlnbi1jb250ZW50OmZsZXgtZW5kfS50Yi1jb250YWluZXIgLnRiLWNvbnRhaW5lci1pbm5lcnt3aWR0aDoxMDAlO21hcmdpbjowIGF1dG99LnRiLWNvbnRhaW5lciAudGItY29udGFpbmVyLWlubmVye3dpZHRoOjEwMCU7bWFyZ2luOjAgYXV0b30gLndwLWJsb2NrLXRvb2xzZXQtYmxvY2tzLWNvbnRhaW5lci50Yi1jb250YWluZXJbZGF0YS10b29sc2V0LWJsb2Nrcy1jb250YWluZXI9IjQxODQxZTExYmMyYWE5NGNkNzNhYTg3ODdhNDQ0YTYwIl0geyBwYWRkaW5nOiAwOyB9ICB9IA==
Bernard-Soulierov sindrom
Bernard – Soulierov sindrom je oboljenje koje karakteriše poremećena funkcija krvnih pločica (trombocita). Takođe, smanjen je i ukupan broj trombocita (trombocitopenija), trombociti su uvećani (megatrombociti) i prisutna je velika sklonost ka krvarenju.
Naime u sindromu postoji deficit jednog glikoproteina (Ib) na površini trombocita za koji se veže von Wilebrandov faktor važan za normalan proces zgrušavanja krvi (koagulaciju), zbog čega su trombociti nesposobni da adherišu (da se vežu) na zid krvnog suda.
Nasljeđuje se autozomno – recesivno (potrebne su dvije kopije gena da bi se bolest ispoljila).
Statistički podaci pokazuju da se javlja veoma rijetko i to kod jedne osobe na milion ljudi u opštoj populaciji.
Intenzitet krvarenja može da varira od veoma blagih, jedva primjetnih, do onih koja ugrožavaju život. Uglavnom se javlja kod pripadnika bijele rase, kao i kod stanovnika Japana. Podjednako se javlja kod oba pola. Krvarenja se mogu javiti već kod novorođenčeta i obično postaju ozbiljnija tokom života.
Kako se manifestuje Bernard – Soulierov sindrom?
Klinički se manifestuje spontanim krvarenjima u koži i sluznicama. Najčešće su to tačkasta krvarenja i krvni podlivi, modrice. Veoma čest simptom je pojava krvarenja iz nosa (epistakse). Često se javljaju i jaka menstrualna krvarenja (metroragija). Nakon povreda i hirurških intervencija može da dođe do veoma ozbiljnih krvarenja. Takođe, može doći i do povraćanja krvi (hematemeze), do pojave crne stolice (melene) i krvi u stolici.
Kako se postavlja dijagnoza Bernard – Soulierovog sindroma?
Dijagnoza se postavlja na osnovu anamneze koja sa kliničkom slikom i detaljnim pregledom može da pomogne da se postavi sumnja, a za definitivno postavljanje dijanoze su neophodni dopunski testovi hemostaze koji ispituju retrakciiju koaguluma, adheziju, agregaciju trombocita, metabolizam prostaglandina. U perifernom razmazu su prisutni veliki, tzv. džinovski trombociti.
Kako se liječi Bernard – Soulierov sindrom?
Liječenje podrazumjeva nadoknadu trombocita. Poželjno je izbjegavanje lijekova koji smanjuju agregaciju trombocita (aspirin).
Kod krvarenja se može koristiti aminokapronska kiseline i dezmopresin, ali samo uz konsultaciju sa ljekarom.
Definitivan lijek, ne postoji.