Bleeding (Excessive): Difference between revisions
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==Overview== | ==Overview== | ||
'''Bleeding''' occurring spontaneously without injury, or bleeding that does not stop (with direct pressure) is abnormal. | |||
==Classification== | |||
Abnormal bleeding can be classified into the following groups: | Abnormal bleeding can be classified into the following groups: | ||
# [[Coagulation factor]] disorders | # [[Coagulation factor]] disorders | ||
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# Vascular disorders | # Vascular disorders | ||
== | == Causes == | ||
In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref> | In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref> | ||
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* Complete physical examination including rectal exam and joint exam ([[hemarthrosis]]) | * Complete physical examination including rectal exam and joint exam ([[hemarthrosis]]) | ||
== Laboratory Findings == | === Laboratory Findings === | ||
* [[Complete blood count]] ([[CBC]]) with [[peripheral smear]] | * [[Complete blood count]] ([[CBC]]) with [[peripheral smear]] | ||
* [[Partial thromboplastin time]] ([[PTT]]) | * [[Partial thromboplastin time]] ([[PTT]]) | ||
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* [[Corticosteroids]] ([[ITP]], [[HSP]]) | * [[Corticosteroids]] ([[ITP]], [[HSP]]) | ||
* [[Tranexamic acid]] ([[liver disease]]) | * [[Tranexamic acid]] ([[liver disease]]) | ||
====Contraindicated medications==== | |||
{{MedCondContrAbs|MedCond = Active pathological bleeding|Dabigatran|Dalteparin|Desirudin}} | |||
=== Surgery and Device Based Therapy === | === Surgery and Device Based Therapy === | ||
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== References == | == References == | ||
{{reflist|2}} | {{reflist|2}} | ||
{{Hematology}} | |||
{{WikiDoc Help Menu}} | |||
{{WikiDoc Sources}} | |||
{{ | [[CME Category::Cardiology]] | ||
{{ | |||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Hematology]] | [[Category:Hematology]] | ||
[[Category:Medical signs]] | |||
[[Category:Signs and symptoms]] | [[Category:Signs and symptoms]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
Latest revision as of 05:19, 15 March 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Bleeding occurring spontaneously without injury, or bleeding that does not stop (with direct pressure) is abnormal.
Classification
Abnormal bleeding can be classified into the following groups:
- Coagulation factor disorders
- Platelet disorders
- Vascular disorders
Causes
In alphabetical order. [1] [2]
- Arteriovenous malformation
- Bernard-Soulier Syndrome
- Capillary wall abnormalities
- Disseminated intravascular coagulation (DIC)
- Drugs:
- Ehlers-Danlos Syndrome
- Glanzmann's Syndrome
- Hemolytic Uremic Syndrome and Thrombotic Thrombocytopenic Purpura (HUS-TTP)
- Hemophilia
- Heparin-Induced Thrombocytopenia
- Hereditary hemorrhagic telangiectasia
- HIV
- Immune Thrombocytopenic Purpura (ITP)
- Isolated factor deficiency
- Leukemia
- Liver disease
- Myelodysplasia
- Pancytopenia
- Schönlein-Henoch Purpura (HSP)
- Senile purpura
- Severe vitamin K deficiency
- Uremia
- Von Willebrand's Disease
Diagnosis
History and Symptoms
- Complete history
- Family history
- Minor trauma bleeding
- Tooth extractions
- Postsurgical bleeding
- Medications
- Menorrhagia
Physical Examination
- Complete physical examination including rectal exam and joint exam (hemarthrosis)
Laboratory Findings
- Complete blood count (CBC) with peripheral smear
- Partial thromboplastin time (PTT)
- Thrombin time
- Bleeding time
- Urinalysis
- Platelet count
- Prothrombin time / international normalized ratio (PT / INR)
Other Diagnostic Studies
- Stool guaiac testing
- Bone marrow aspiration
- Specific factor assays
- Platelet adhesion and aggregation testing
- Urea clot lysis test
- Fibrinogen assay
- Mixing studies
Treatment
- Treatment of underlying disease processes
- Remove offending drugs
- Transfusion and hemostasis
- Rapid IV hydration
- Supplemental oxygen
- Administration of fresh frozen plasma (DIC and liver disease)
- Administration of cyroprecipitate (uremia, DIC, von Willebrand's disease and hemophilia)
- Intravenous immunoglobulin (IVIG) for patients with ITP in emergency situations
- Factor VIII concentrate (von Willebrand's disease and hemophilia)
Acute Pharmacotherapies
- Desmopressin (DDAVP) for uremia, von Willebrand's and hemophilia
- Parenteral vitamin K (vitamin K deficiency)
- Corticosteroids (ITP, HSP)
- Tranexamic acid (liver disease)
Contraindicated medications
Active pathological bleeding is considered an absolute contraindication to the use of the following medications: