Clinical features of inherited and acquired bleeding disorders. Approach to a patient ofbleeding disorder jk science. Disorders of the blood can affect the management of dental patients. The disorders results fro abnormality of vessel ii. Pipettes should preferably be accurate within signifi cantly less than 10%. Bleeding disorders diagnostic approaches to bleeding disorders nigel s.
There is also another bleeding disorder known as acquired haemophilia, which is not inherited like the classical form of haemophilia. Approach to bleeding disorder coagulation defects in children. Download pdf bleedingdisorders free online new books. Types of bleeds continued nose bleeds put on gloves, head upright, and apply continuous pressure. The bleeding occurs immediately upon the injury that induces it. Approach to bleeding disorders in icu authorstream presentation. Detailed questioning should be carried out on the following topics, for both the patient and family members. Approach to a child with bleeding disorder seminar 1 free download as powerpoint presentation. If obstetriciangynecologists suspect that a patient has a bleeding disorder, they should work in coordination with a hematologist for laboratory evaluation and medical management. Not all require therapy, monitor for further platelet declines or signs of bleeding. 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. There must be a logical systematic approach and a discriminate use of laboratory investigations to reach the diagnosis and assess severity.
An approach to the management of bleeding disorders. Bleeding disorders are relatively rare genetic disorders characterized by increased or prolonged bleeding due to abnormal coagulation the ability of the blood to clot. Particular emphasis should be placed on family and drug history. 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. An approach to the management of bleeding disorders on. Approach to patients with bleeding disorders in the. Our diagnostic approach to mild bleeding disorders. A guide for patients and families by mondimore, francis mar more from my sitebipolar disorder. 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. 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. The approach to a patient with a bleeding disorder needs a comprehensive detailed history and thorough physical examination. Laboratory approach inhibitor suspected screen for precipitating antibodies inhibitor screen.
The local hemostatic control involved the use of fibrin glue beriplast. 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. The severity of the bleeding disorder can vary greatly. Jun 02, 2012 a bleeding tendency is a presentation with bleeding in a patient in whom no anatomical cause for the bleeding i. Pdf normal hemostasis requires the interaction of platelets and the clotting cascade with normal blood vessels and supporting tissues. Diagnostic guidelines for mild bleeding disorders are still often based on expert opinion and experience, and can differ between countries. A guide for patients and families by mondimore, francis mar.
Approach to a child with bleeding disorder seminar 1. The evaluation of patient with bleeding disorders must be made in a logical sequence so as to uncover the nature of bleeding disorders, thus. Bleeding disorders is a general term for a wide range of medical problems that lead to poor blood clotting and continuous bleeding. If a pipette is inaccurate beyond the following limits mean weight, it must be taken out of use immediately. Symptoms such as bruising and epistaxis occur frequently in children without. Coagulopathy also called a bleeding disorder is a condition in which the bloods ability to coagulate form clots is impaired. 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. Dec 05, 2015 acquired bleeding disorders in the aging population are of concern because they are not readily diagnosed. 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. A bleeding tendency is a presentation with bleeding in a patient in whom no anatomical cause for the bleeding i. Single site of bleeding usually rapid with minimal coagulation test abnormalities 2.
Eighty patients with various bleeding disorders underwent 5 extractions without preventive replacement hematologic therapy. Nov 21, 2016 clinical features of inherited and acquired bleeding disorders. Approach to bleeding disorder coagulation defects in. Cdc collaborates with public and private organizations in conducting research to better understand bleeding disorders affecting women and girls. Approach to a patient of bleeding disorder bleeding. How to approach thrombocytopenia hematology american. Women with bleeding disorders judy kauffman, rn, ms, cpnp. This bleeding can be in many cases like during an accident, trauma condition, surgery, injury or a menstrual cycle. Eating disorder functional overall energy deficit gonadotropin deficiency e. Pdf the approach to a patient with a bleeding disorder.
With dr shafqat inam, haematology registrar at concord hospital and royal prince alfred hospital, new south wales, australia. A guide for patients and families 3rd edition pdf author mondimore isbn b00m3srez6 file size 3. A bleeding disorder is an acquired or inherited tendency to bleed excessively mechanisms of bleeding vascular. Easy bruising, epistaxis, menorrhagia and bleeding with oropharyngeal surgery are the most common manifestations. Bleedind disorder is a set of disorders, or disease which normally affect the process of clotting of our blood. An approach to a patient with bleeding disorder semantic scholar.
Laboratory approach to the diagnosis of mild bleeding disorders. A focused hematologic history is necessary to determine whether a patient has a bleeding disorder. Nursing working group nurses guide to bleeding disorders page 1 of 8 introduction to bleeding disorders regina b. Hemostasis general diagnostic approach to the bleeding. A congenital bleeding disorder is often suspected when there is a lifelong historyof bleeding and a family historyof a bleeding disorder andor consanguinity. Thrombocytopenia with infection is usually caused by bone marrow suppression. 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 diagnostic approach to mild bleeding disorders boender 2016. Diagnosis of hemophilia and other bleeding disorders.
Ppt bleeding disorders powerpoint presentation free to. Approach to the diagnosis and management of common bleeding. Extrasurgical site bleeding causing a fall in hemoglobin level of 20. It is then inferred that the bleeding is due to a functional impairment of the normal hemostatic process. Clotting is dependent on functional platelets, coagulation factors and vasoconstriction. 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. In a study, community physicians from various specialties were presented with a hypothetical older adult woman complaining of recurrent epistaxis. Normal hemostasis requires the interaction of platelets and the clotting cascade with normal blood vessels and supporting tissues. Bleeding disorders affect females as well as males. Women with bleeding disorders can experience complications, such as heavy menstrual bleeding called menorrhagia and bleeding after pregnancy that can affect their overall health. Results of the third us national health and nutrition examination survey nhanes iii support the traditional value of 150. In some cases, the thrombocytopenia is also immunemediated. Clinicians who care for newborns are all too frequently faced with the desperate situation of the seriously bleeding neonate.
Acquired haemophilia a aha is a rare but potentially lifethreatening bleeding disorder characterized by autoantibodies directed against coagulation factor viii. This bleeding can be in many cases like during an accident, trauma condition, surgery, injury or a. The evaluation of a patient with a possible bleeding disorder can be one of the most challenging referrals in hematology. 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. 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. A bleeding child is a cause of great concern and often, panic, for parents and pediatricians alike. Thrombocytopenia is defined as a platelet count below the 2. Isth advanced training course, portugal march 2014. Bleeding disorder is a set of disorders, or disease which normally affect the process of clotting of our blood. Pdf diagnostic approach to inherited bleeding disorders. They have advanced hemostatic function accounts for less severe bleeding seen management. 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. Based on etiology, they can be categorized into disorders affecting platelets or the coagulation cascade and can be inherited or acquired.
Introduction bleeding, technically known as hemorrhaging, is the loss of blood escaping from the circulatory system. A free powerpoint ppt presentation displayed as a flash slide show on id. Hemophilia and other bleeding disorders comprehensive program for bleeding disorders. However, a negative history of bleeding in the absence of hemostatic challenge does not exclude a bleeding disorder. Approach to the child of jehovahs witness with a bleeding.
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. 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. May 21, 2016 our diagnostic approach to mild 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.
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. An approach to the management of bleeding disorders on the. None of the 43 patients with coagulopathies other than severe hemophilia suffered bleeding after extractions. Jan 04, 2015 the truth about mobile phone and wireless radiation dr devra davis duration. 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. This eviewsilie approach to a patient suffering from or having any evidence of bleeding disorder. A diagnostic approach to mild bleeding disorders boender. The truth about mobile phone and wireless radiation dr devra davis duration. Measures the activity of the intrinsic and common pathways of coagulation. Approach to a child with bleeding in the emergency room. Acquired bleeding disorders in the elderly hematology. 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. 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. Skin findings such as purpura and petechiae can be important determinants of a potential bleeding disorder.
Download pdf bleedingdisorders free online new books in. Most hemorrhagic problems are emergencies, requiring rapid diagnosis and prompt management to stop bleeding. Multiple site or unusual pattern with abnormal coagulation tests 2. Accurate clinical analysis of suspected bleeding disorder requires acquaintance with the common causes of bleeding. Any treatment must be designed according to the needs of the individual and the resources available. The approach to a suspected bleeding disorder in children and adolescents is discussed separately. The evaluation of a patient with bleeding disorders can bc divided into two parts.
Causes of bleeding could be trivial or secondary to an underlying bleeding disorder or a potentially serious systemic illness. 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. Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a womans physical, social, emotional, or material quality of life. However, since one of the clotting factors is decreased or absent, a mature fibrin clot is not formed. 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. In this article i will present a practical approach to rapid diagnosis. Two general patterns of bleeding symptoms are useful in distinguishing disorders of platelet plug formation and coagulation defects. Bleeding disorders meera shreedhara 82508 what is it. Outline 2 introduction history taking physical finding investigation references 3. Is the bleeding local or due to a hemostatic failure.
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