Bleeding disorders diagnostic approaches to bleeding disorders nigel s. Local use of fibrin glue is a safe and costeffective tool to treat patients with severe bleeding disorders. Approach to the child of jehovahs witness with a bleeding. Acquired bleeding disorders in the elderly hematology. Based on etiology, they can be categorized into disorders affecting platelets or the coagulation cascade and can be inherited or acquired. Nursing working group nurses guide to bleeding disorders page 1 of 8 introduction to bleeding disorders regina b. Approach to patients with bleeding disorders in the. Bleeding disorders meera shreedhara 82508 what is it. If obstetriciangynecologists suspect that a patient has a bleeding disorder, they should work in coordination with a hematologist for laboratory evaluation and medical management. Hemophilia and other bleeding disorders comprehensive program for bleeding disorders. A diagnostic approach to mild bleeding disorders boender. There must be a logical systematic approach and a discriminate use of laboratory investigations to reach the diagnosis and assess severity.
Bleeding disorders are relatively rare genetic disorders characterized by increased or prolonged bleeding due to abnormal coagulation the ability of the blood to clot. Isth advanced training course, portugal march 2014. Approach to a patient of bleeding disorder in hematology practice, bleeding disorders form a sizeable number of patients these disorders may be obvious or so subtle that they can be over looked. Key university of minnesota medical school, minneapolis, minnesota, usa introduction and general approach the evaluation of a patient with a possible bleeding disorder can be one of the most challenging referrals in hematology practice. If rn, ms, cpnp the original chapter on women with bleeding disorders for this manual was written by the late renee paper, rn, ccrn who was a woman with a bleeding disorder and a tireless pioneer advocate for women who bleed. The severity of the bleeding disorder can vary greatly. Diagnostic guidelines for mild bleeding disorders are still often based on expert opinion and experience, and can differ between countries. Any treatment must be designed according to the needs of the individual and the resources available.
The evaluation of patient with bleeding disorders must be made in a logical sequence so as to uncover the nature of bleeding disorders, thus. The truth about mobile phone and wireless radiation dr devra davis duration. A diagnostic approach to mild bleeding disorders boender 2016. This is a very rare condition where a persons immune system develops antibodies against one of their bodys own clotting factors and results in a. However, a negative history of bleeding in the absence of hemostatic challenge does not exclude a bleeding disorder. Particular emphasis should be placed on family and drug history. Coagulopathy also called a bleeding disorder is a condition in which the bloods ability to coagulate form clots is impaired. Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a womans physical, social, emotional, or material quality of life.
Nov 21, 2016 clinical features of inherited and acquired bleeding disorders. Normal hemostasis requires the interaction of platelets and the clotting cascade with normal blood vessels and supporting tissues. A congenital bleeding disorder is often suspected when there is a lifelong historyof bleeding and a family historyof a bleeding disorder andor consanguinity. Eating disorder functional overall energy deficit gonadotropin deficiency e. It is then inferred that the bleeding is due to a functional impairment of the normal hemostatic process. Disorders of the blood can affect the management of dental patients.
How to approach thrombocytopenia hematology american. An inherited bleeding disorder is suggested by the 1 onset of bleeding symptoms in infancy and childhood, 2 a positive family history particularly if it reveals a consistent genetic pattern, and 3 laboratory evidence of a single or isolated abnormality, most commonly the deficiency of a single coagulation factor. Bleedind disorder is a set of disorders, or disease which normally affect the process of clotting of our blood. Download pdf bleedingdisorders free online new books in.
A focused hematologic history is necessary to determine whether a patient has a bleeding disorder. Approach to the child of jehovahs witness with a bleeding disorder dr marita macken st6 paediatrics haematology oncology 28 th april 2017 tp conference from in utero and beyond. This bleeding can be in many cases like during an accident, trauma condition, surgery, injury or a menstrual cycle. Bleeding due to platelet abnormalities, whether due to reduced number or abnormal function of platelets, is usually small vessel bleeding, and produces such findings as petechiae, bruising, gum bleeding, or nosebleeds. Hemostasis general diagnostic approach to the bleeding. Bleeding disorders is a general term for a wide range of medical problems that lead to poor blood clotting and continuous bleeding. Approach to the diagnosis and management of common bleeding. In a person with a bleeding disorder, the first two stages of hemostasis function normally the blood vessels constrict, an immature platelet plug is formed, and bleeding may stop or slow down. They have advanced hemostatic function accounts for less severe bleeding seen management. Ttp drug,preg thrombocytopenia, microangiopathic hemolytic anemia with end organ damage think of ttp in a pt with renal failure, fluctuating neuro deficit and fever ldh raised, schistocyte with normal coagulation studies tt 1.
An approach to a patient with bleeding disorder semantic scholar. Approach to a patient of bleeding disorder bleeding. Dec 05, 2015 acquired bleeding disorders in the aging population are of concern because they are not readily diagnosed. Diagnosis of hemophilia and other bleeding disorders. Jan 04, 2015 the truth about mobile phone and wireless radiation dr devra davis duration. Approach to bleeding disorder coagulation defects in. This bleeding can be in many cases like during an accident, trauma condition, surgery, injury or a. Women with bleeding disorders judy kauffman, rn, ms, cpnp. Results of the third us national health and nutrition examination survey nhanes iii support the traditional value of 150. Approach to bleeding disorder coagulation defects in children. None of the 43 patients with coagulopathies other than severe hemophilia suffered bleeding after extractions. In some cases, such as nose bleeds, large bruises and heavy menses, it is the clinicians responsibility to discern whether the patient has a clinically significant bleeding disorder that may predispose to excessive or potentially serious bleeding.
Thrombocytopenia with infection is usually caused by bone marrow suppression. Pdf normal hemostasis requires the interaction of platelets and the clotting cascade with normal blood vessels and supporting tissues. Approach to a child with bleeding disorder seminar 1 free download as powerpoint presentation. Bleeding disorders affect females as well as males. Easy bruising, epistaxis, menorrhagia and bleeding with oropharyngeal surgery are the most common manifestations.
A free powerpoint ppt presentation displayed as a flash slide show on id. A guide for patients and families by mondimore, francis mar more from my sitebipolar disorder. The bleeding occurs immediately upon the injury that induces it. This is a very rare condition where a persons immune system develops antibodies against one of their bodys own clotting factors and results in a reduced factor level in their blood. Cdc collaborates with public and private organizations in conducting research to better understand bleeding disorders affecting women and girls. A bleeding disorder is an acquired or inherited tendency to bleed excessively mechanisms of bleeding vascular. The evaluation of patient with bleeding disorders must be made in a logical sequence so as to uncover the nature of bleeding disorders, thus facilitating the choice of laboratory studies. Our diagnostic approach to mild bleeding disorders.
A bleeding child is a cause of great concern and often, panic, for parents and pediatricians alike. Pipettes should preferably be accurate within signifi cantly less than 10%. Thrombocytopenia is defined as a platelet count below the 2. Bleeding disorder is a set of disorders, or disease which normally affect the process of clotting of our blood.
An approach to the management of bleeding disorders on the. An approach to the management of bleeding disorders on. Symptoms such as bruising and epistaxis occur frequently in children without. Acquired haemophilia a aha is a rare but potentially lifethreatening bleeding disorder characterized by autoantibodies directed against coagulation factor viii. Bleeding that is symptomatic and occurs in a critical area, such as intracranial, intraspinal, intraocular, retroperitoneal, pericardial, in a nonoperated joint, or intramuscular with compartment syndrome, 3. May 21, 2016 our diagnostic approach to mild bleeding disorders. This eviewsilie approach to a patient suffering from or having any evidence of bleeding disorder. A guide for patients and families by mondimore, francis mar. Single site of bleeding usually rapid with minimal coagulation test abnormalities 2. Approach to bleeding disorders in icu authorstream presentation. Download pdf bleedingdisorders free online new books. Introduction bleeding, technically known as hemorrhaging, is the loss of blood escaping from the circulatory system.
Two general patterns of bleeding symptoms are useful in distinguishing disorders of platelet plug formation and coagulation defects. However, since one of the clotting factors is decreased or absent, a mature fibrin clot is not formed. Clotting is dependent on functional platelets, coagulation factors and vasoconstriction. Causes of bleeding could be trivial or secondary to an underlying bleeding disorder or a potentially serious systemic illness.
Skin findings such as purpura and petechiae can be important determinants of a potential bleeding disorder. Approach to a child with bleeding in the emergency room. Diagnostic approaches to bleeding disorders nigel s. Ppt bleeding disorders powerpoint presentation free to. Accurate clinical analysis of suspected bleeding disorder requires acquaintance with the common causes of bleeding. Multiple site or unusual pattern with abnormal coagulation tests 2. The approach to a suspected bleeding disorder in children and adolescents is discussed separately. Diagnostic testing for specific platelet and coagulation factor disorders and overviews of the hemostatic process and the uses of specific coagulation tests are presented separately. A 2002 cdc study of obstetricians and gynecologists in georgia found that only 4% of the doctors who responded would have considered vwd as a possible cause of heavy menstrual bleeding. A guide for patients and families 3rd edition pdf author mondimore isbn b00m3srez6 file size 3. The evaluation of a patient with a possible bleeding disorder can be one of the most challenging referrals in hematology. An approach to the management of bleeding disorders. Measures the activity of the intrinsic and common pathways of coagulation. Not all require therapy, monitor for further platelet declines or signs of bleeding.
Laboratory approach inhibitor suspected screen for precipitating antibodies inhibitor screen. Women with bleeding disorders can experience complications, such as heavy menstrual bleeding called menorrhagia and bleeding after pregnancy that can affect their overall health. Pdf diagnostic approach to inherited bleeding disorders. The approach to a patient with a bleeding disorder needs a comprehensive detailed history and thorough physical examination. If a pipette is inaccurate beyond the following limits mean weight, it must be taken out of use immediately. Most hemorrhagic problems are emergencies, requiring rapid diagnosis and prompt management to stop bleeding. In some cases, the thrombocytopenia is also immunemediated. Detailed questioning should be carried out on the following topics, for both the patient and family members. Laboratory approach to the diagnosis of mild bleeding disorders. These autoantibodies constitute the most common spontaneous inhibitor to any coagulation factor and may induce spontaneous bleeding in patients with no previous history of a bleeding disorder. The evaluation of a patient with bleeding disorders can bc divided into two parts.
This condition can cause a tendency toward prolonged or excessive bleeding bleeding diathesis, which may occur spontaneously or following an injury or medical and dental procedures. The clinical appreciation of the presence and severity of bleeding symptoms is a fundamental step in the evaluation of patients referred for a possible bleeding disorder 1. Pdf the approach to a patient with a bleeding disorder. Tendency to bleed longer or regularly with or without injury. Is the bleeding local or due to a hemostatic failure.
In this article i will present a practical approach to rapid diagnosis. A bleeding tendency is a presentation with bleeding in a patient in whom no anatomical cause for the bleeding i. In a study, community physicians from various specialties were presented with a hypothetical older adult woman complaining of recurrent epistaxis. With dr shafqat inam, haematology registrar at concord hospital and royal prince alfred hospital, new south wales, australia. Jun 02, 2012 a bleeding tendency is a presentation with bleeding in a patient in whom no anatomical cause for the bleeding i. These guidelines are intended to help develop basic standards of care for the management of hemophilia and do not replace the advice of a medical advisor andor product insert information. Eighty patients with various bleeding disorders underwent 5 extractions without preventive replacement hematologic therapy.
Our first step is to obtain both the family and a detailed personal bleeding history, followed by a physical examination. Types of bleeds continued nose bleeds put on gloves, head upright, and apply continuous pressure. Extrasurgical site bleeding causing a fall in hemoglobin level of 20. Outline 2 introduction history taking physical finding investigation references 3. Women with bleeding disorders judy kauffman, rn, ms, cpnp the original chapter on women with bleeding disorders for this manual was written by the late renee paper, rn, ccrn who was a woman with a bleeding disorder and a tireless pioneer advocate for women who bleed. Clinical features of inherited and acquired bleeding disorders. There is also another bleeding disorder known as acquired haemophilia, which is not inherited like the classical form of haemophilia. The disorders results fro abnormality of vessel ii. Approach to a child with bleeding disorder seminar 1. Approach to a patient ofbleeding disorder jk science. Clinicians who care for newborns are all too frequently faced with the desperate situation of the seriously bleeding neonate.
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