28.2 Bruising & Bleeding in children

Question 1

what sites are significatn for bruising?

Answer 1

trunk, buttock, iliac spines, arms/face, often large

Question 2

history for bleeding?

Answer 2

duration, stops, starts, sites

Question 3

common sites for bleeding?

Answer 3

fums, nose, mouth
haematemesis/maleana
haematuria
CNS bleeding
joint/muscles
menorrhagia

Question 4

what initial investigations for bruising/bleeding?

Answer 4

FBE, pilm, platelet morphology

• coags
• mixing studies
• platelet function analyser
• group and hold

Question 5

low platelet count think?

Answer 5

isolated thrombocytopaenia or pancytopenia

Question 6

what factor missing in haemophilia A?

Answer 6

Factor VIII

Question 7

what factor missing in haemophilia B?

Answer 7

Factor IX

Question 8

what factor missing in haemophilia C?

Answer 8

factor XI

Question 9

where is factor VIII made?

Answer 9

liver

Question 10

factor VIII needs protection in circulation from?

Answer 10

Von willebrand’s factor

Question 11

hallmark of haemophilia?

Answer 11

spontaneous haemarthroses

Question 12

general management of haemophilia?

Answer 12

no aspirin
no IM injections
bracelet
no contact sport
-regular dental check ups
viral infection monitoring

Question 13

mx of bleeding in haemophilia A?

Answer 13

factor VIII recombinant

Question 14

in a mild haemophilia A, what can we trial?

Answer 14

DDAVP - analog to antidiuretic hormone, good for minor procedures, may not work for all

Question 15

why do prophylaxis in severe haemophilia?

Answer 15

protect the joints

Question 16

how to treat a haemophiliac with high inhibitor antibodies to factor VIII?

Answer 16

• use recombinant factor VIIa

- transexamic acid

Question 17

typical von willibrand’s presentation?

Answer 17

easy bruising
epistaxis
menorrhagia
blood loss with dental extraction/surgery

Question 18

ITP stands for?

Answer 18

immune thrombocytopaenia

Question 19

ITP clinical presentations?

Answer 19

sudden insidious onset of bruising/petechiae, nose bleeds

otherwise well

Question 20

typical ITP bloods show?

Answer 20

normal Hb, WBC, MCV, film

Question 21

how does ITP happen?

Answer 21

autoantibodies against platelets

Question 22

ITP, new definition, how many platelets?

Answer 22

<100

Question 23

ITP typical disease course in kids?

Answer 23

90% have spontaneous remission within 12 months from dx

Question 24

Rx of ITP?

Answer 24

Pred
IVIG*** fastest
(use in acute bleeding)
Anti-D
Rituximab
splenectomy
thrombopoeitin receptor agonists