Acquired Bleeding Disorders

Question 1

What is ITP?

Answer 1

Immune Thrombocytopenic Purpura.

Caused by the destruction of circulating platelets by anti-platelet IgG autoantibodies and is thought to be a post viral reaction.

Note can be congenital.

Causes usually a very low thrombocytopenia.

Question 2

How does ITP present?

Answer 2

Presents between 2-10 years of age.

Often presents with petechiae or purpura. May cause epistaxis or mucosal bleeding.

Severe bleeding is rare.

Question 3

What atypical features should raise concern and what should be investigated for?

Answer 3

Any atypical features such as:

• anaemia
• neutropenia
• hepatosplenomegaly
• marked lymphadenopathy

Any of these should make you investigate for ALL, aplastic anaemia or SLE.

Question 4

What is the treatment for ITP?

Answer 4

Usually self limiting and children usually recover in 6-8 weeks.

Note ~20% take a chronic course lasting >6months (screen for SLE).

If there is any major bleeding or recurrent minor bleeding then treatment should be used.

Oral Prednisolone
IV anti D/ IV Ig

Platelet transfusion should be reserved for life threatening bleeds.

Question 5

What are the acquired disorders of coagulation?

Answer 5

Liver Disease
ITP
DIC
Inadequate intake/absorption of Vitamin K

Question 6

What is the most likely diagnosis:

3 day old boy who had oozing following heel prick test?

Answer 6

Haemophilia

Question 7

What is the most likely diagnosis: neonate with rib bruising?

Answer 7

NAI

Question 8

What is the most likely diagnosis:

8yo girl with bruising on arms and legs 2 weeks after a cold?

Answer 8

ITP

Question 9

What is the most likely diagnosis:

1 year old boy struggling to walk with joint swelling and pain?

Answer 9

Haemophilia

Question 10

What is the most likely diagnosis:

12yo girl suffering from menorrhagia?

Answer 10

vWD

Question 11

What is DIC?

Answer 11

Disseminated Intravascular Coagulation.

It is a disorder of coagulation pathway activation leading to diffuse fibrin deposition in the microvasculature of many organs –> multiple organ failure, and consumption of coagulation factors and platelets –> bleeding

Question 12

What causes DIC?

Answer 12

It is most commonly caused by severe sepsis or shock.

Question 13

How does DIC present?

Answer 13

Clinical features are bruising, purpura and haemorrhage. Will also have clinical features of underlying cause.

Question 14

How is DIC treated?

Answer 14

Treat the underlying cause (usually sepsis) whilst providing intensive care.

Supportive care may be needed by fresh frozen plasma, cryoprecipitate, platelets or anti-thrombin.