Acquired bleeding disorders alli south african medical. Pdf bleeding disorders are divided into two broad categories, i. Owing to the low prevalence of inherited coagulation disorders, routine screening for inherited coagulation disorders is not recommended except in the face of a personal or immediate family history of bleeding. Acquired hemophilia is significantly rarer than the inherited form, affecting around 2 per million of the population 2. Whereas bleeding into joints hemar throsis is the hallmark of severe congenital hemophilia, this is unusual in acquired hemophilia where the prin cipal manifestations are bleeding into skin purpura and soft tissues. Patients usually present predominantly with mucocutaneous bleeding, with no previous history of bleeding. Approach to patients with bleeding disorders in the. In contrast to inherited haemorrhagic disorders, where generally a single haemostatic abnormality is found, multiple haemostatic defects are commonly present in. Mar 22, 2018 bleeding disorders are usually taken to mean coagulopathies with reduced clotting of the blood. Treatment varies, depending on the condition and its severity.
Summary acquired bleeding disorders are the most common causes of bleeding seen in the practice of hematology. These disorders can lead to heavy and prolonged bleeding after an injury. Symptoms such as gum bleeding, epistaxis, menorrhagia, petechiae, and bruising are especially common. In a study, community physicians from various specialties were presented with a hypothetical older adult woman complaining of recurrent epistaxis. Platelet defects typically manifest with petechiae and mucosal bleeding. Types of bleeding disorders national hemophilia foundation.
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. Some bleeding disorders can result in severe bleeding. Acquired bleeding disorders encompass a heterogeneous group of conditions with varied and often complex aetiologies. Management of rare acquired bleeding disorders marzia menegatti 1 fondazione istituto di ricovero e cura a carattere scientifico irccs ca granda ospedale maggiore policlinico, angelo bianchi bonomi hemophilia and thrombosis center, milan, italy.
Identification and basic management of bleeding disorders in. Platelet disorders are the most common cause of bleeding disorder and are usually acquired rather than inherited. Volume 3 of acquired bleeding disorders in children is a handy, compact, uptodate reference on a wide variety of nonhereditary bleeding problems in children. Figures 1 and 2 illustrate typical examples of extensive purpura due to acquired hemophilia. Bleeding disorders coagulation disorders jama jama network. Management of significant acquired bleeding disorders. Acquired coagulation inhibitorassociated bleeding disorders. The rare coagulation disorders paula hb boltonmaggs introduction the rare coagulation disorders are inherited abnormalities of hemostasis that may present significant difficulties in diagnosis and management. Identification and basic management of bleeding disorders.
Acquired disorders of coagulation medicine journal uk. Division of hematologyoncology, department of pediatrics, the university of texas southwestern medical center at dallas, and the center for cancer and blood disorders. Department of pediatrics and communicable diseases, university of michigan, ann arbor, mich after completing this article, readers should be able to. Pediatric coagulation disorders american academy of pediatrics. The approach to a suspected bleeding disorder in children and adolescents is discussed separately. Bleeding disorders may result from faults at many different levels in the coagulation cascade.
Coagulation guidelines for unexplained bleeding disorders. Inherited and acquired coagulation disorders practical. Bleeding disorders are relatively rare genetic disorders characterized by increased or prolonged bleeding due to abnormal coagulation the ability of the blood to clot. Acquired abnormalities of the procoagulant system are typically associated underlying systemic disorders. The overall frequency of these disorders in the general population is low with the exception of factor xi deficiency. Management of rare acquired bleeding disorders hematology. This condition can cause a tendency toward prolonged or excessive bleeding.
Acquired bleeding disorders concise guide to hematology wiley. Dec 06, 2019 the clinical picture of an acquired bleeding disorder includes a wide spectrum of clinical manifestations ranging from minimal or no bleeding to lifethreatening events. Guideline for the diagnosis and management of the rare. Nov 16, 2018 acquired bleeding disorders can be categorized in quantitative or qualitative platelet defects, impaired clotting factor synthesis or low coagulation factors caused by inhibiting antibodies, and consumption coagulopathies. Inherited disorders are passed down through genetics. Coagulation disorders american academy of pediatrics. Antithrombotic treatment may be another frequent cause of an acquired bleeding disorder. Approach to patients with bleeding disorders in the emergency department. Bleeding disorders slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Platelet defects typically manifest with petechiae and mucosal bleeding, whereas coagulation defects usually present as spontaneous or excessive hemorrhage.
Pdf acquired bleeding disorders abd are commonly encountered in both inpatient and outpatient settings. Coagulopathy also called a bleeding disorder is a condition in which the bloods ability to coagulate form clots is impaired. Nursing working group nurses guide to bleeding disorders page 1 of 8 introduction to bleeding disorders regina b. As with inherited haemostatic disorders see part 1, in practice, january2002, pp210, theclinical expression ofthe bleeding associated. Diagnostic testing for specific platelet and coagulation factor disorders. The cause is a decrease in amount or function of one of the 11 proteins in the blood, called clotting factors, that work together to make the blood clot. It begins with one of the best available overviews of the interaction between platelets, plasma coagulation factors, and blood vessel endothelium.
Acquired bleeding disorders tintinallis emergency medicine. Describe the clinical management of bleeding disorders. The most common acquired abnormalities seen in the clinical setting are covered in this article, including vitamin k deficiency, warfarin therapy, liver disease. Local use of fibrin glue is a safe and costeffective tool to treat patients with severe bleeding disorders. The pattern of bleeding in acquired hemophilia differs from that in congenital hemophilia. Identification and basic management of bleeding disorders in adults. Pdf diagnosis and management of common acquired bleeding. Bleeding disorders are divided into two broad categories, i. Two large case series, one from iran 10 and the other from israel 14, describe umbilical bleeding and mucosal hemorrhage as the most common bleeding problems.
Fibrinogen disorders with severe bleeding manifestations are uncommon. Understand laboratory testing and indications in the diagnosis of a bleeding disorder and timing of subspecialty referral. The cause of abnormal bleeding can be found by blood tests for the number and function of platelets and the levels of the clotting factors. Diagnosis and management of acquired bleeding disorders. List clinical signs and symptoms suggestive of a congenital or acquired bleeding disorder. Haemophilia is a group of inherited bleeding disorders characterized by a lifelong defect in the clotting mechanism. A normal hemostasis screen excludes by far the majority of acquired defects, and further investigation, other than a repeat of the bleeding time, is rarely needed.
Congenital bleeding disorders are caused by defects or damage in the genes and are present at birth. Laboratory approach to a suspected acquired bleeding disorder. Bleeding disorders are usually taken to mean coagulopathies with reduced clotting of the blood. Acquired disorders can develop or spontaneously occur later in life. Bleeding disorders coagulation disorders jama jama. Santen introduction normal regulation of bleeding is a complex process involving platelets and the coagulation system see chapter 232, tests of hemostasis. Clinical evaluation of patients presenting with a bleeding disorder often provides clues as to whether the abnormality resides in coagulation factors, platelets or blood vessels.
The clinical picture of an acquired bleeding disorder includes a wide spectrum of clinical manifestations ranging from minimal or no bleeding to lifethreatening. Acquired bleeding disorders can be categorized in quantitative or qualitative platelet defects, impaired clotting factor synthesis or low coagulation factors caused by inhibiting antibodies, and consumption coagulopathies. Acharya, md bleeding disorders and thrombosis program, cohen childrens medical center of new york, new hyde park, new york drs sarangi and acharya contributed to the conceptualization, content, and composition of the manuscript and approved the. Patients with no previous personal or family history of bleeding may have suddenonset hemorrhagic manifestations, sometimes fatal, especially if an early diagnosis. Sometimes tests for other diseases are necessary if the bleeding disorder is one of the acquired types. Work up extracted from literature and modified by university of. Bleeding disorders in congenital syndromes susmita n. Because no sites of active bleeding were identified, no additional treatment was initiated. Bleeding disorders are a group of conditions that result when the blood cannot clot properly. Acquired bleeding disorders include disseminated intravascular coagulation dic, vitamin k deficiency, massive transfusion, renal and liver disease and hyperfibrinolysis. Develop a diagnostic algorithm for evaluating patients.
How i investigate for bleeding disorders hayward 2018. This paper will discuss and outline the dental management of patients with acquired bleeding disorders. As with the conventional inherited form, it appears in all ethnic groups and has a worldwide prevalence. Summary characteristics of the rare coagulation disorders. Thrombophilia is a group of inherited or acquired coagulation disorders that is associated with an increased risk of thrombotic events such as vte and pulmonary embolism. Acquired disorders of coagulation may be the consequence of many underlying conditions, and although they may share abnormality of a coagulation test, e. Both significant thrombocytopenia and qualitative platelet dysfunction are commonly manifested by the presence of nonpalpable petechiae, often most pronounced in the lower extremities and in areas where. Bleeding disorders characterised by abnormal platelet function or blood vessel walls that result in increased bleeding. These diseases are almost always inherited, although in rare cases they can develop later in life if the body forms antibodies that fight against the bloods natural clotting factors. Acquired bleeding disorders in children, vol 3, abnormalities. Acquired bleeding disorders osullivan major reference. Musculoskeletal bleeding was not infrequent, and cerebral bleeding was reported. Current clinical practice acquired coagulation inhibitorassociated bleeding disorders. The clinical picture of an acquired bleeding disorder includes a wide spectrum of clinical manifestations ranging from minimal or no bleeding to lifethreatening events.
Some bleeding disorders can result in severe bleeding following an accident or injury. However, unlike their inherited counterparts, acquired bleeding disorders usually resultfrommultiple defects in the haemostaticresponse. Describe the clinical features suggestive of an underlying bleeding disorder. Accurate clinical analysis of suspected bleeding disorder requires acquaintance with the common causes of bleeding. When it was increased to 10,000 kiuml and swish and swallow rinses of tranexamic acid before and after the dental extractions were added, only 3 of 25 hemophilia patients suffered from secondary bleeding. As a result, people with bleeding disorders experience extended bleeding after injury, menstruation, trauma, or surgery, and in many situations depending on the severity, spontaneous bleeding into joints, muscles, or other parts of their bodies. The condition is often not recognized or mistaken for other acquired bleeding disorders such as disseminated intra. Congenital or acquired abnormalities of the procoagulant factors result in a bleeding and thrombotic tendency of variable severity. The spectrum of bleeding disorders in women with menorrhagia.
Bleeding due to inherited disorders is the subject of discussion in part 1 current issue, and in part 2 forthcoming issue the focus is on bleeding from acquired causes. Patients usually present predominantly with mucocutaneous bleeding, with no previous history of bleeding abnormalities and no clinically meaningful family history. His activated partial thromboplastin time gradually improved, and no further bleeding or bruising occurred. Dental management of patients with drugrelated acquired bleeding disorders abstract. They can be inherited or appear due to a genetic mutation. Dec 05, 2015 acquired bleeding disorders in the aging population are of concern because they are not readily diagnosed. Bleeding disorders are a group of conditions in which there is a problem with the bodys blood clotting process. Bleeding is a common symptom and does not always indicate an underlying bleeding disorder. Acquired bleeding disorders are those that develop after birth or spontaneously occur in the individual. A history of a bleeding tendency should be followed by appropriate laboratory investigations. Clinical evaluation of patients presenting with a bleeding disorder often provides. The patient was admitted to hospital and given oral prednisone therapy 60 mgd. Acquired bleeding disorders in the elderly hematology. In general, it is not a predictor of bleeding for surgical procedures.
As with inherited haemostatic disorders see part 1, in practice, january 2002, pp 210, the clinical expression of the bleeding associated with acquired disorders. Nsaids, antibiotics, psych drugs bleeding disorders have 2 general characteristics. Adults with bleeding disorders may present to their family physician with minor. You can find information on other bleeding disorders by following the links at the bottom of this page. Sometimes tests for other diseases are necessary if the bleeding disorder is one of the acquired. Investigations for bleeding disorders are warranted when a patient presents with a personal andor family history of bleeding, andor laboratory abnormalities that suggest an inherited or acquired bleeding disorder. The first of this series of three articles discussed the dental management of patients with inherited bleeding disorders. One of them is acquired hemophilia, which is an autoimmune disorder arising from antibodies against factor viii. Acquired bleeding disorders south african medical journal. Management of rare acquired bleeding disorders ash publications.