This document discusses bleeding disorders, including their classification and diagnosis. It begins by introducing hemostasis and the coagulation cascade. Bleeding disorders are then classified into four categories: coagulation factor deficiencies, fibrinolytic defects, vascular disorders, and platelet disorders. The diagnosis of bleeding disorders involves considering clinical information like symptoms and family history, as well as laboratory tests such as bleeding time, platelet count, prothrombin time, and D-dimer level. Taking a thorough medical history is important for properly evaluating patients with potential bleeding disorders.

1. Presented by:
Rajat Hegde
BLEEDING DISORDERS:
CLASSIFICATION AND DIAGNOSIS

2. CONTENTS
 Introduction
 Hemostasis
 Coagulation cascade
 Classification
 Diagnosis
 Laboratory tests
 Conclusion
 References

3. INTRODUCTION
• Bleeding disorders are rare disorders affecting the way the body
controls bleeding.
• Excessive bleeding can result from:
1. Increased fragility of vessels
2. Platelet deficiency or dysfunction
3. Derangement of coagulation
• The normal hemostatic response involves the blood vessel wall, the
platelets and the clotting cascade.
• Various laboratory tests are used in evaluation of a bleeding
diathesis.

4. Blood vessel injury triggers the following sequence:
1. Vessel constriction.
2. Circulating platelets adhere to vessel.
3. A series of enzymatic reactions involving coagulation proteins,
produces fibrin to form a stable hemostatic plug.

5. HEMOSTASIS
Hemostasis is the mechanism that leads to cessation of bleeding from
a blood vessel.
Primary Hemostasis:
• Platelet plug formation at sites of injury.
Secondary Hemostasis:
• Plasma coagulation system reaction resulting in fibrin formation.

6. COAGULATION CASCADE

8. CLASSIFICATION
I) Coagulation Factor Deficiency:
Congenital:
• Hemophilia A and B
• von Willebrand Disease
• Other factor deficiencies
II) Fibrinolytic Defects:
• Streptokinase therapy
• DIC
Acquired
• Liver disease
• Vitamin K deficiency
• DIC

9. III) Vascular Disorders:
• Scurvy
• Purpura
• Hereditary hemorrhagic telangiectasia
• Cushing syndrome
• Ehlers Danlos syndrome

10. IV) Platelet Disorders:
1] Quantitative Disorders (Thrombocytopenia):
2] Qualitative Disorders:
Congenital:
• Glanzmann thrombasthenia
• von Willebrand disease
Acquired:
• Liver disease
• Drug-induced
• Alcoholism
Immune Mediated:
• Idiopathic
• Collagen vascular disease
• Sarcoidosis
Non-Immune Mediated:
• Microangiopathic hemolytic anemia
• Leukemia
• Myelofibrosis

11. DIAGNOSIS OF BLEEDING DISORDERS
Terminologies:
• Petechiae: small, pinpoint bleeding spot, measures 1-2 mm.
• Purpura: red, non-blanching maculo-paular lesions caused by
intradermal capillary bleeding. Measures ≥ 3mm.
• Ecchymosis: A discoloration of skin resulting from bleeding
underneath, typically caused by bruising. Measures ≥ 1cm.
• Hematoma: A pool of partially clotted blood in an organ, tissue or
body space, usually caused by a broken blood vessel.

12. • It’s important to have relevant clinical information before
interpreting results.
• From the history, it’s important to differentiate hereditary
disorders from acquired.
• Hereditary disorders generally start from an early age or
recurrent in nature and may have family history.
• Acquired disorders on the other hand occur at any age and have an
underlying predisposing cause.
• Depending on type of bleeding, it’s important to differentiate
between platelet and factor bleeds.

13. • History of medication should include replacement therapy, use of
anticoagulants like heparin besides intake of analgesics and
antibiotics etc.
• In general, symptoms of:
1. Platelet bleeds: petechial hemorrhage, mucosal bleed.
2. Coagulation factor disorders: deep abdominal bleeds, muscle
bleeds, hemostasis, ecchymotic patches.

14. LABORATORY TESTS
• Bleeding time
• Clotting time
• Platelet count
• Activated partial thromboplastin time (aPTT)
• Prothrombin time (PT)
• Thrombin time (TT)
• D-dimer
Bleeding Time:
• It’s the time from puncture of skin and stoppage of blood oozing out.
• Normal Range: 2 – 5 mins
• Prolonged in platelet disorders: thrombocytopenia, thrombocytopenic
purpura.

15. Clotting Time:
• It’s the time required for blood to form a clot.
• Normal Range: 4 - 10 mins
• Prolonged in: Hemophilias, vitamin K deficiency.
aPTT (Activated Partial Thromboplastin Time):
• It’s performed by adding a surface activator (like kaolin/ellagic
acid), phospholipid and calcium to patient’s plasma.
• Normal Range: 26 – 37 sec
• Prolonged aPTT: Hemophilia A and B, von Willebrand disease, DIC,
heparin therapy.

16. Prothrombin Time:
• It’s measured by adding tissue factor (thromboplastin) and calcium to
the patient’s plasma.
• Normal Range: 12 – 16 sec
• Prolonged in: liver diseases, DIC, vitamin K deficiency,
D-dimer:
• It’s a fibrin degradation product, a small protein fragment present in
the blood after a blood clot is degraded by fibrinolysis.
• It contains 2 cross-linked D fragments of the fibrinogen protein.
• D-dimer concentration helps to diagnose thrombosis.
• While negative result practically rules out thrombosis, positive result
can indicate thrombosis but does not rule out other potential causes.

17. CONCLUSION
• The medical and family history is very important in evaluating
patients with bleeding disorders.
• Dental extractions are very common major stresses of hemostatic
mechanism, and a prior history is very important.
• So, a thorough understanding and knowledge about bleeding
disorders is very much needed for dental professionals to minimise
the complications of many treatment procedures.

18. REFERENCES
 Robbins and Cottran Pathologic Basis of Disease.
 Davidson’s Essentials of Medicine.

19. THANK YOU