Hematology and Oncology Book

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Bleeding DisorderAka: Bleeding Diathesis

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  1. See Also
    1. Clotting Pathway
  2. Causes
    1. Coagulation Bleeding Disorders
      1. See Coagulopathy in Pregnancy
    2. Platelet Bleeding Disorders
      1. Also See Thrombocytopenia
      2. Also See Drug Induced Platelet Dysfunction
    3. Blood Vessel Wall Bleeding Disorders
  3. Signs: Abnormal Bleeding (multiple sites)
    1. Nasopharynx
      1. Epistaxis
      2. Bleeding gums
    2. Gastrointestinal
      1. Hematemesis
      2. Melana
    3. Gynecologic
      1. Menorrhagia
      2. Postpartum Hemorrhage
    4. Musculoskeletal
      1. Muscle hematomas
      2. Hemarthrosis
    5. Skin
      1. Purpura
      2. Petechiae
    6. Trauma
      1. Excessive bleeding from minor wounds
      2. Excessive bleeding following surgery or dental procedures
      3. Intracerebral bleeding event
  4. Labs: Initial
    1. Complete Blood Count with platelets
    2. Peripheral blood smear
    3. ProTime (PT) with INR
    4. Partial Thromboplastin Time (PTT)
  5. Labs: Based on initial testing
    1. Normal PT, PTT, and Platelet Count/morphology
      1. Obtain Platelet Function Closure Time (PFCT, Platelet Function Analyzer-100)
      2. PFCT Aggregation occurs with collagen/Epinephrine membrane only
        1. Drug Induced Platelet Dysfunction
      3. PFCT Aggregation occurs with both membranes (Epinephrine and ADP)
        1. Von Willebrand's Disease
    2. Partial Thromboblastin Time (PTT) abnormality
      1. PTT corrects with a PTT Mixing Study (mixed with normal blood)
        1. Obtain Factor VIII, Factor IX, and Factor XI assays
        2. Consider Von Willebrand's testing if low Factor VIII
      2. PTT does not correct with a PTT Mixing Study (mixed with normal blood)
        1. Obtain Lupus Anticoagulant
        2. Obtain Factor VIII Inhibitor
    3. ProTime (PT) or INR abnormal
      1. PT/INR corrects with Vitamin K Supplementation
        1. Replace Vitamin K as needed
        2. Assess for malnutrition and malabsorption causes of Vitamin K Deficiency
      2. PT/INR does not correct with Vitamin K Supplementation
        1. Obtain Factor VII assay
    4. ProTime (PT/INR) and Partial Thromboplastin Time Abnormal
      1. Comorbid advanced liver disease
      2. Disseminated Intravascular Coagulation (DIC)
      3. Anticoagulant use (Warfarin or Heparin)
    5. Platelet abnormality
      1. See Platelet Bleeding Disorders
      2. See Drug Induced Platelet Dysfunction
      3. See Thrombocytopenia
  6. References
    1. Allen (2002) Pediatr Clin North Am 49:1239
    2. Ballas (2008) Am Fam Physician 77:1117

Bleeding tendency (C1458140)

ConceptsPathologic Function (T046)
EnglishBleeding diathesis, Bleeding diathesis -RETIRED-, Bleeding disorder, Bleeding disorders, Bleeding tendency, Tendency to bleed
Spanishdiatesis hemorragica, diatesis hemorragica - RETIRADO -, tendencia al sangrado, tendencia hemorragica, trastorno hemorragico
Parent ConceptsDuplicate concept (C1274013), Blood, lymphatics/immune system observable (C1274019), Reason not stated concept (C1276325)
SourcesCOSTAR, CST, MEDLINEPLUS, MTH, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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