Scribd Logo
Upload

Welcome to Scribd!

  • 9 views

    Bleeding

    Uploaded by

    Ayyob Suliman

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Bleeding

    Uploaded by

    Ayyob Suliman
    9 views27 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    9 views27 pages

    Bleeding

    Uploaded by

    Ayyob Suliman

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 27

    Bleeding Disorders

    Dr Fatima Abuzaid
    Content
    • Background and important definitions.
    • Rapid review of Hemostasis.
    • Recognition of Bleeding presentation.
    • Explain systematic approach to bleeding child.
    • Categorize Hematological and non
    hematological cause of bleeding.
    • Overview of treatment.
    Background
    • Bleeding: Extravasations of blood.
    Important definitions
    • Bleeding time: Time needed to stop bleed
    after an injury(usually 3-5 minutes).
    • Clotting Time: Time required to form clot
    (normal 5-15minutes)
    • Pro-Coagulant: Inactive form of coagulant
    proteins.
    • Coagulation cascade: chain of chemical
    reaction to activate pro-coagulant and end
    result transform pro-thrombin to thrombin.
    Hemostasis
    Thrombosis Bleeding
    Following an Injury
    • Vasospasm.
    • Platelet plug formation : Collagen exposure
    Platelet Adhesion(VWB), Platelet activation
    secret ADP, serotonin, Tromboxane A2 lead to
    platelet aggregation.
    • Coagulation
    Coagulation cascade
    Causes of Bleeding
    • Vascular:
    – Vasculitis; e.g HSP.
    – Vascular malformation: Hereditary Telangectasia.
    – Extravascular; Ehlers Danlos syndrome
    • Platelet:
    – Low Number
    – Dysfunction
    • Coagulation:
    – Intrinsic
    – Extrinsic
    – Both
    Platelet defect
    • Low Number:
    – Decrease production(Aplastic, Acute Leukemia)
    – Increase destruction(ITP,SLE)
    – Consumption(DIC,HUS)

    • Abnormal function:
    – Bernard Soulier syndrome
    – Glanzman thrombosthenia
    – Others; Uremia, Drugs..etc
    Coagulation defect
    • VWB deficiency.
    • Hemophilia A.
    • Hemophilia B.
    • Factor VII.
    • Factor XIII.
    • Complex factor deficiency.
    • Others( Liver disease, drugs, DIC..etc)
    History
    • Onset, Trauma, Amount, site, Course, Duration.
    • Site; Epistaxis, Hematemesis, Melena, Bruises
    • Red flags(weight loss, Bone pain, Fever and night
    sweat).
    • Lethargy, Pallor, Breathlessness, Abdominal pain,
    Confusion.
    • History of URTI.
    • PMHx (vaccination, Circumcision, Drugs)
    • Family history.
    Examination
    • Local examination.
    • Vital signs(CRT,HR,RR, Bp).
    • Lymph nodes, Spleen, Liver(stigmata of liver
    disease).
    • Anthropometric measurements and skin.
    • Systemic examination(Musckuloskeletal).
    Investigation
    • CBC, DCT, Blood film, viral screen, blood group,
    cross match, Crp and Septic screen.
    • Bleeding time.
    • PTT,PT, and INR.
    • Liver function.
    • D.dimer, Fibrinogen.
    • Platelet function(aggregation).
    • Factor levels.
    • BMA & Biopsy.
    Treatment
    Treatment
    • ABC.
    • Compression(open wound).
    • Local treatment with Tranixemic acid.
    • Check vitals assess hemodynamic state.
    • Consider blood transfusion.
    • Tranixemic acid IV.
    • If overdose or poison > Antidote.
    • Replacement therapy(concentrate/CPP/FFP).
    Treatment
    • ITP: Steroid, IV IG
    • Aplastic Anemia; PlT transfusion(def BMT)
    • Thrombosthenia; Platelet transfusion.
    • Leukemia: Chemotherapy, BMT.
    • N.B; PLT transfusion is contraindicated in ITP
    unless life threatening bleeding.
    Case scenario
    • 2 year old boy presented with Right Knee
    swelling, restriction of movement no fever.

    • Take focused history


    Investigation
    • CBC
    • WBC =5000 HGB=10 Plt=210
    • PT=13 PTT=68 INR=1.2

    • Factor VIII <1%


    Hemophilia
    • X linked recessive disease
    • A Factor VIII deficiency
    • B Factor IX deficiency
    • Heamarthrosis, Hematoma, circumcision and
    post vaccination bleeding.
    • Prolonged PTT
    • Mild 5-30% Moderate 1-5% Sever <1%
    • Treatment: Factor VIII or IX.
    ITP
    • Idiopathic, auto-immune in nature
    • Usually proceeded by URTI
    • Skin and mucus membrane bleedin,
    sometimes Heamturia and CNS bleeding.
    • Diagnosis of exclusion.
    • Blood film shows large platelet.
    • Treated with IVIG or Steroids
    • Second line Eltrobopag.
    Questions?

    You might also like