Hemorrhagic disorders

• Hemorrhagic disorders


  Inability to form a proper blood clot, extended bleeding after injury, surgery, trauma, or menstruation

  
• Bleeding disorders


  Improper clotting caused by defects in blood components such as platelets and/or clotting proteins, also called clotting factors

  
• Terms used in hemorrhagic disorders

  • Petechiae
  • Purpura
  • Ecchymosis
  • Epistaxis
  • Hemarthrosis
  • Hematemesis
  • Hematoma
  • Hematuria
  • Hemoglobinuria
  • Hemoptysis
  • Melena
  • Menorrhagia

  
• Petechiae


  Purplish red pinpoint hemorrhagic spots in the skin

  
• Purpura


  Produced by hemorrhage of blood into small areas of skin, mucous membranes and other tissues

  
• Ecchymosis


  Form of purpura - blood escapes into large areas of skin or mucous membranes but not into deep tissues

  
• Epistaxis


  Nosebleed, loss of blood from the tissue that lines the inside of the nose

  
• Hemarthrosis


  Leakage of blood into a joint cavity
• Hematemesis


  Vomiting of blood, from the upper gastrointestinal tract

  
• Hematoma


  Subcutaneous bleeding, blood escapes into large areas of skin or mucous membranes but not into deep tissues

  
• Hematuria


  Blood in urine, either visible (gross) or microscopic

  
• Hemoglobinuria


  Hemoglobin in urine, when red blood cells break down in the blood vessels

  
• Hemoptysis


  Coughing up blood from the respiratory tract
• Melena


  Black, tarry stool containing blood from the upper gastrointestinal tract
• Menorrhagia


  Excessive menstrual bleeding, lasting more than 7 days or very heavy
• Types of bleeding

  • Localized bleeding
  • Generalized bleeding
  • Mucocutaneous hemorrhage
  • Anatomic hemorrhage
• Localized bleeding


  Single location, usually indicates injury, infection, tumor, or isolated blood vessel defect
• Generalized bleeding


  Multiple sites, spontaneous and recurring bleeds, potential evidence for a disorder of primary hemostasis or thrombocytopenia

  
• Mucocutaneous hemorrhage


  Bleeding at skin or body orifices, petechiae, purpura, ecchymoses, associated with thrombocytopenia, platelet disorders, VWD, or vascular disorders
• Anatomic hemorrhage


  Internal bleeding, soft tissue, muscles, joints (hemarthroses), associated with secondary hemostasis defects like coagulation factor deficiencies
• Hemostasis laboratory testing


  • Acquired bleeding
  • Congenital bleeding

  
• Acquired bleeding


  Bleeding episodes begin after childhood, associated with disease or physical trauma, not duplicated in relatives
• Congenital bleeding


  Uncommon, usually diagnosed in infancy or early childhood, recurrent hemorrhages that may be spontaneous or after minor injury
• Bleeding disorders


  • Vascular abnormalities
  • Clotting factor abnormalities
  • DIC
  • Platelet disorders
• Ehlers-Danlos Syndrome


  • Defect in peptidase enzyme that converts procollagen to collagen, hyperextensible joints, fragile tissues and hyperplastic skin, easy bruising, bleeding from gums, GIT bleeding
• Pseudoxanthoma elasticum


  • Calcified and structurally abnormal elastic fibers in small arteries, hemorrhagic episodes, subarachnoid and GIT bleeding
• Vitamin C deficiency (Scurvy)


  • Dietary deficiency of vitamin C, required for intact vascular basement membrane, gum bleeding, hemorrhage into subcutaneous tissues and muscles, petechiae
• Senile Purpura


  • Chronic sun exposure, degeneration of collagen, elastin and subcutaneous fat, red to purple ecchymosis
• Rendu-Osler-Weber Syndrome


  • Vascular malformations and surface skin lesions (telangiectasias), small blood vessels are focally disorganized and dilated, poor wall support and diminished ability to contract

  
• Congenital Hemangioma (Kasabach-Meritt)


  • Tumors composed of vessels, swells and bleeds at the surface, require surgical removal, fibrin clots, platelet consumption and red cell destruction due to vascular obstruction
• Henoch-Schonlein Purpura


  • Palpable purpura, abdominal pain due to GIT hemorrhaging, joint pain, microscopic hematuria or proteinuria
• Platelet disorders


  • Qualitative
  • Quantitative
• Qualitative platelet disorders


  Platelet function is abnormal, includes adhesion defects, aggregation defects, and release disorders
• Quantitative platelet disorders


  Abnormal platelet number, includes decreased production (ITP) and increased destruction
• Henoch's purpura


  Associated with abdominal pain due to GIT hemorrhaging
• Schonlein's


  Associated with joint pain, especially on knees, ankles and wrists
• Henoch-Schonlein Purpura


  Occurs when Henoch's and Schonlein's occur together
• Henoch-Schonlein Purpura


  • Palpable purpura that may blanch
  • Seen on lower extremities and buttocks
  • Colicky abdominal pain
  • Intussusception (ileoileal)
  • Heme positive stool
  • Microscopic hematuria or proteinuria
  • Periarticular disease of knees and ankles

  
• Bleeding Disorders


  • Vascular abnormalities
  • Platelet disorders
  • Clotting factor abnormalities
  • DIC
• Platelet Disorders


  Can be divided into disorders of platelet function and number