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Bleeding neonate / child
- 1. Bleeding neonate / child CAUSES AND CLINICAL FEATURES
- 3. Hemostasis INJURY CollagenExposure Platelet Adhesion and release reaction Platelet aggregation VASOCONSTRICTION Serotonin Platelet Phospolipid Thromboxane A2 ADP Primary haemostatic plug Stable haemostatic plug Tissue Factor Coagulation Thrombin Fibrin Fibrinolysis
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- 5. Coagulation Disorders Platelet Dysfunction Vascular Fibrinolytic disorders
- 6. Coagulation Disorders InheritedAcquired • Hemophilia A and B • von Willebrand Disease • Factor VII, X, XIII deficiency • Afibrinogenemia • Liver disease • Vitamin K deficiency • Warfarin overdose • DIC
- 7. Platelet Dysfunction QuantitativeQualitative • Decreased production • Increased destruction • Inherited ▫ Glanzmann thrombasthenia ▫ Bernard Soulier syndrome ▫ Gray platelet syndrome ▫ Wiskott Aldrich syndrome • Acquired ▫ Medications ▫ CRF ▫ Cardiopulmonary bypass
- 8. Thrombocytopenia • ITP • TORCH • Infections ▫ Kala azar, DHF, malaria, hepatitis B and C, HIV • Medications ▫ Valproate, penicillins, heparin, quinine, digoxin • Malignancies ▫ Leukemia, lymphoma, neuroblastoma • Collagen vascular disorders
- 9. • Bone marrowfailure syndromes ▫ Thrombocytopenia with absent radii ▫ Fanconi anemia • Immunodeficiency syndromes ▫ Wiskott Aldrich syndrome • Others ▫ Hypersplenism, HUS, NAIT
- 11. Vascular causes •Henoch Schonlein purpura • Connective tissue disorder • Scurvy • Prolonged steroid use • Hereditary hemorrhagic telangiectasia
- 12.
- 15. NEONATES • Oozingfrom umbilical stump • Cephalhematoma • Bruising, petechiae • Bleeding from site for venipuncture or procedure site • Bleeding from scalp • Intracranial hemorrhage • Bleeding from mucous membranes
- 16. OTHERS • Mucosalbleeds • Joint or muscle bleed • Bleeding after minor trauma • Petechiae and purpurae • Ecchymoses • Fever with rash • Hepatosplenomegaly • Significant lymphadenopathy • Menorrhagia
- 17. HISTORY • Ageof onset • Sex • Frequency • Location / type of bleeding • Duration • Medications • Family history • Associated symptoms
- 18. Examination • Pallor • Petechiae, ecchymoses, rashes • Hepatosplenomegaly • Local examination of mouth and nose • Lymphadenopathy • Features of bone marrow failure • Any associated features
- 19. Platelet vs coagulationdisorders Platelet Disorder Coagulation Disorder Site Skin, mucous membranes Deep in soft tissues, joint, muscles Petechiae Yes No Ecchymoses Small, superficial Large, deep Bleeding after minor trauma Yes No Bleeding after surgery Immediate, mild Delayed, severe Examples von Willebrand disease, ITP Hemophilia A and B