28.2 Bruising & Bleeding in children Flashcards
what sites are significatn for bruising?
trunk, buttock, iliac spines, arms/face, often large
history for bleeding?
duration, stops, starts, sites
common sites for bleeding?
fums, nose, mouth haematemesis/maleana haematuria CNS bleeding joint/muscles menorrhagia
what initial investigations for bruising/bleeding?
FBE, pilm, platelet morphology
- coags
- mixing studies
- platelet function analyser
- group and hold
low platelet count think?
isolated thrombocytopaenia or pancytopenia
what factor missing in haemophilia A?
Factor VIII
what factor missing in haemophilia B?
Factor IX
what factor missing in haemophilia C?
factor XI
where is factor VIII made?
liver
factor VIII needs protection in circulation from?
Von willebrand’s factor
hallmark of haemophilia?
spontaneous haemarthroses
general management of haemophilia?
no aspirin no IM injections bracelet no contact sport -regular dental check ups viral infection monitoring
mx of bleeding in haemophilia A?
factor VIII recombinant
in a mild haemophilia A, what can we trial?
DDAVP - analog to antidiuretic hormone, good for minor procedures, may not work for all
why do prophylaxis in severe haemophilia?
protect the joints
how to treat a haemophiliac with high inhibitor antibodies to factor VIII?
- use recombinant factor VIIa
- transexamic acid
typical von willibrand’s presentation?
easy bruising
epistaxis
menorrhagia
blood loss with dental extraction/surgery
ITP stands for?
immune thrombocytopaenia
ITP clinical presentations?
sudden insidious onset of bruising/petechiae, nose bleeds
otherwise well
typical ITP bloods show?
normal Hb, WBC, MCV, film
how does ITP happen?
autoantibodies against platelets
ITP, new definition, how many platelets?
<100
ITP typical disease course in kids?
90% have spontaneous remission within 12 months from dx
Rx of ITP?
Pred IVIG*** fastest (use in acute bleeding) Anti-D Rituximab splenectomy thrombopoeitin receptor agonists
