This document discusses the approach to bleeding disorders. It begins by stating that bleeding disorders are usually caused by coagulation disorders, platelet disorders, or vessel wall abnormalities. It then covers the causes of bleeding disorders which can be congenital, acquired, or drug-induced. The document provides details on taking a history and evaluating symptoms for different types of bleeding disorders. It discusses various laboratory tests used in diagnosis, such as prothrombin time, partial thromboplastin time, and bleeding time. Specific bleeding disorders like hemophilia A, hemophilia B, and von Willebrand disease are described. Finally, it notes that disseminated intravascular coagulation and liver or renal diseases can also cause acquired bleeding disorders.

1. APPROACH TO BLEEDING
DISORDERS

2. BLEEDING DISORDERS
Bleeding disorders are usually due to one of the
following abnormalities:
• Coagulation disorders
• Platelet disorders
• Vessel wall abnormalities

3. CAUSES OF BLEEDING DISORDERS
1. CONGENITAL
2. ACQUIRED
3. DRUG INDUCED

4. CONGENITAL

5. ACQUIRED

6. DRUG INDUCED

7. HISTORY TAKING
• Unprovoked bleeding and muscle
hemorrhages suggest hemophilia
• Mucocutaneous bleeding- platelet
disorders, thrombocytopenia, or von
Willebrand disease
• Extend of hemorrhage
• Collecting objective information:
1. Previous hospital visits
2. result of laboratoric evaluation
3. previous transfusions of blood
4. h/o anemia, treatment with iron

8. • Medication history- esp. non-
prescription drugs
❑Drug induced thrombocytopenia is
common
❑medication may also effect the kidney
and liver cells
❑Herbal and alternative medication-
eg.Ginkgo biloba
❑other dietary supplements

9. • Nutritional history
❑ Vitamin k deficiency, esp if the patient also is
taking broad spectrum antibiotics
❑ Vitamin C deficiency, manifest as scurvy
❑ general malnutrition or malabsorption
• Family history
❑ Sex linked: Hemophilia A orB
❑ AD: most forms of vWD
❑ AR: coagulation factor deficiencies, platelet
disorders, type 3 vWD

10. • Population genetic information
eg. Ashkenazi Jews- Factor XI deficiency
• Underlying diseases:
❑Cirrhosis,
❑renal insufficiency-
❑myeloproliferative disorder
❑a/c leukemia
❑myelodysplasia
❑SLE
❑Gaucher disease

11. CLINICAL FEATURES

13. PRESENTING COMPLAINTS
• Epistasis- platelet
disorder, vWD
• Gingival hemorrhage-
vWD
• Oral mucous membrane
bleeding-
thrombocytopenia
• Skin hemorrhage-
petechiae, ecchymoses
PETECHIAE
ECCHYMOSES

14. • Severity of skin hemorrhage- size, frequency, spontaneous or
only with trauma
• Colour of the bruise
-Red bruise -Jet black bruise
Cushing syndrome Warfarin induced
Senile purpura
• Tooth extractions
• Excessive bleedong in response to razor nicks- common in
platelet disorders, vWD
• Hemoptysis
• Hematemesis
• hematuria

15. Diagnosis
• Prothrombin time-
PT is prolonged in deficiency of factors
VII, V ,X, II, I.
Normal: 10-13 sec
• Partial thromboplastin time-
For factor XII
• Mixing study
• Thombin time(normal:11-15sec)
reduced fibrinogen level
use of heparin

16. • Bleeding time
Assesses the function of platelets
normal: 4-8 min
prolonged in qualitative platelet defect,
vWD, platelet count <1 lakh

17. INTERPRETATION

22. HAEMOPHILIA A
• Factor VIII deficiency
• Genetics: X- linked
• Clinical features:
Spntaneous bleeding into skin
Retroperitoneal bleeding
Intracranial bleeding
• Management:
Raising the Factor VIII level

23. HAEMOPHILIA B
• Aberration of Factor IX
• Also X-linked
• management with factor IX concentrate

24. von Willebrand disease
• Impaired function of von Willebrand factor
• It forms the bridge between platelet and
subendothelial tissue
• Clinical features:
Superficial bruising
Epistaxis
Menorrhagia
GI haemorrhage

25. ACQIRED BLEEDING DISORDERS
Disseminated intravascular coagulation is an important
cause of bleeding
• Liver disease:
❑Factor V, VII, VIII, IX, X, XI, prothrombin, and
fibrinogen
❑Portal hypertension,Cholestatic jaundice
• Renal failure
severity of the hemorrhagic state in renal failure is
proportional to plasma urea concentration

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