BLEEDING DISORDERS Flashcards
Causes of bleeding disorders
Haemophilia
Von Willebrand disease
Liver disease
Vitamin K deficiency especially in newborns
Bone marrow failure e.g. aplastic anaemia and leukaemia
Low platelet count from any cause
Disseminated Intravascular Coagulation
Drug induced
Nature of bleeding in platelet and vessel wall defects
Bleeding is usually into skin and mucosal surfaces like the gums, nose, gastrointestinal tract
Nature of bleeding in coagulation factor deficiency
Bleeding is into deep tissues like the brain,
joints and muscles.
Signs seen in bleeding disorders
Pallor
Excessive bleeding
Localised swelling due to bleeding into body spaces e.g. Joints
Tenderness
Limitation of movement and joint deformities
Purpura, petechiae, ecchymosis
Symptoms of bleeding disorders
Spontaneous bleeding from mucous membranes or cuts
Easy bruising, bleeding from orifices
Excessive bleeding from cuts or incisions
Deformed joints from recurrent joint bleeds
Swelling at site of blood collection (pseudotumours)
Pain limiting movement
Nature of bleeding in newborns with vitamin K deficiency
Spontaneous bleeding occurs from various
sites such as the umbilical cord, gastrointestinal tract, scalp and brain
Investigations done in bleeding disorders
FBC and blood film comment
Platelet count
Liver function tests
Prothrombin time, INR, partial thromboplastin time
Bleeding time
Non-pharmacological interventions in bleeding disorders
Apply regulated pressure dressing and/or ice packs to minimise bleeding where possible
Stop any event/drugs responsible for bleeding or which may aggravate bleeding
Educate haemophiliacs on their disease, encouraging them to minimise trauma-prone activities, and to inform doctors of their condition before any surgical procedure
Avoid unnecessary injections and surgical procedures in all patients
Physiotherapy on affected joints
Surgery
Purpura vs petechiae vs ecchymosis
Purpura occurs when small blood vessels leak blood under the skin.
Purpura measure between 4 and 10 mm (millimeters) in diameter.
When purpura spots are less than 4 mm in diameter, they are called petechiae.
Purpura spots larger than 1 cm (centimeter) are called ecchymoses.
Treatment objectives in bleeding disorders
To prevent or arrest bleeding
To identify and correct underlying cause
Treatment for hemophilia A
Recombinant Factor VIII, intravenous,
1 international unit raises % of Factor VIII on average by 2 per kg body weight
Required units = body weight (kg) x desired factor rise x 0.5
(Repeated as needed)
Or
Desmopressin, Intranasal, 150 microgram spray into each nostril, 12 hourly. May be repeated for 3 days
Treatment for bleeding due to underlying liver disease
Vitamin K, IV,
Adults
5-10 mg stat.
Children
3-5 mg stat.
Neonates (irrespective of history of vitamin K injection)
Term; 1 mg stat.
Preterm; 500 micrograms stat.
And
Fresh Frozen Plasma, IV,
Adults, Children, Neonates
15-20 ml/kg
General Measures in bleeding disorders: fluid replacement following acute severe blood
loss
Sodium Chloride 0.9%, IV,
Adults
Children and Neonates
20 ml/kg bolus stat.
Repeat if there is no clinical improvement
And
Concentrated red cell transfusion, IV,
Adults, Children and Neonates
3 ml/kg for each expected 1 g/dL haemoglobin rise
Treatment for hemophilia B
Recombinant Factor IX
Administration of 1 unit/kg factor IX (recombinant) generally increases
factor IX levels by approximately 0.8% in adults and 0.7% in children <15 years of age
Treatment for Von Willebrand disease
Desmopressin, Intranasal, 150 microgram spray into each nostril, 12hourly. May be repeated for 3 days
