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== Differential Diagnosis ==
{| class="infobox" style="border: 0; float: right; width: 24%; position: fixed; top: 210px; right: 14px; background: #104E8B; border-radius: 10px 10px 10px 10px; margin: 0 0 0 0; padding: 5px 5px; font-weight: bold;"
Different causes of the bleeding disorders can be differentiated based on their clinical manifestation and laboratory findings.
| style="text-align: center; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); font-size: 120%;" | [[Sepsis|{{fontcolor|#F8F8FF|Sepsis in Adult Patients}}]]
 
These features have discussed in the below table:
{|  
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Category
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Subcategory
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |History
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestation
! colspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory testing
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Comments
|-
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mucosal bleeding
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Petechia
[[{{PAGENAME}}#Diagnostic Criteria|{{fontcolor|#F8F8FF|Diagnostic Criteria}}]]
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ecchymoses
<li>[[{{PAGENAME}}#Systemic Inflammatory Response Syndrome|{{fontcolor|#F8F8FF|SIRS}}]]</li>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Menorrhagia
<li>[[{{PAGENAME}}#Sepsis|{{fontcolor|#F8F8FF|Sepsis}}]]</li>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hematoma
<li>[[{{PAGENAME}}#Severe Sepsis|{{fontcolor|#F8F8FF|Severe Sepsis}}]]</li>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemarthrosis
<li>[[{{PAGENAME}}#Septic Shock|{{fontcolor|#F8F8FF|Septic Shock}}]]</li>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Plt
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PTT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TT
|-
|-
! rowspan="16" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Platelet disorders
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
! rowspan="7" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Thrombocytopenia]]
[[{{PAGENAME}}#Causes|{{fontcolor|#F8F8FF|Causes}}]]
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Infection]]-Induced [[thrombocytopenia]]<span name="harr_c115s002s001s002p001"></span><span name="9100754"></span>
| align="left" style="background:#F5F5F5;" |  
* History of prior infection
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | ↓
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | −
|-
|-
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Medication|Medications]]-Induced [[Thrombocytopenia|thrombocy]]<span name="harr_c115s002s001s003p001"></span><span name="9100757"></span>[[Thrombocytopenia|topenia]]
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
| align="left" style="background:#F5F5F5;" |
[[{{PAGENAME}}#FIRE: Focused Initial Rapid Evaluation|{{fontcolor|#F8F8FF|Focused Initial Rapid Evaluation}}]]
*History of [[Medication|medications]] such as:
** [[Furosemide]]
** [[Non-steroidal anti-inflammatory drug|Nonsteroidal anti-inflammatory drugs]] ([[Non-steroidal anti-inflammatory drug|NSAIDs]])
** [[Penicillin]]
** [[Quinidine]]
** [[Quinine]]
** [[Ranitidine]]
** [[Sulfonamide (medicine)|Sulfonamides]]
** [[Linezolid]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | ↓
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Most important part of treatment is discontinuing of the medication.
|-
|-
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Heparin-Induced Thrombocytopenia|Heparin-Induced thrombocytopenia]]<span name="harr_c115s002s001s004p001"></span><span name="9100761"></span>
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
| align="left" style="background:#F5F5F5;" |
[[{{PAGENAME}}#Empiric Antibiotic Therapy|{{fontcolor|#F8F8FF|Empiric Antibiotic Therapy}}]]
* [[Thrombosis]]
* Unexplained [[thrombocytopenia]] up to 3 weeks after the end of [[heparin]] therapy
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | ↓
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | For more information click here: [[Heparin-induced thrombocytopenia]].
|-
|-
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Idiopathic thrombocytopenic purpura|Immune Thrombocytopenic Purpura]] ([[Idiopathic thrombocytopenic purpura|ITP]])<span name="harr_c115s002s001s005p001"></span><span name="9100771"></span>
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
| align="left" style="background:#F5F5F5;" |  
[[{{PAGENAME}}#Dos|{{fontcolor|#F8F8FF|Dos}}]]
* History of prior [[infection]] or no history
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | ↓
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | −
|-
|-
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |Inherited [[Thrombocytopenia]]<span name="harr_c115s002s001s006p001"></span><span name="9100783"></span>
| style="padding: 2px 10px; background: #4479BA; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
| align="left" style="background:#F5F5F5;" |
[[{{PAGENAME}}#Don'ts|{{fontcolor|#F8F8FF|Don'ts}}]]
* Positive family history
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | ↓
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | −
|-
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Thrombotic thrombocytopenic purpura|Thrombotic Thrombocytopenic Purpura]] ([[Thrombotic thrombocytopenic purpura|TTP]])<span name="harr_c115s002s002s001p001"></span><span name="9100787"></span>
| align="left" style="background:#F5F5F5;" | History of:
*[[Cancer]]
*[[Bone marrow transplantation]]
*[[Pregnancy]]
*[[Medication]]
**[[Platelet]] aggregation inhibitors ([[ticlopidine]] and [[clopidogrel]])
**Immunosuppressants ([[cyclosporine]], [[mitomycin]], [[tacrolimus]]/FK506, [[interferon|interferon-α]])
*[[HIV-1]] infection
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | ↓
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | −
|-
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Hemolytic-uremic syndrome|Hemolytic Uremic Syndrome]]<span name="harr_c115s002s002s002p001"></span><span name="9100796"></span>
| align="left" style="background:#F5F5F5;" |History of:
* [[Infections]]
* [[Malignancy]], [[chemotherapy]], and [[ionizing radiation]]
* [[Calcineurin inhibitor]]s and [[transplantation]]
* [[Pregnancy]], [[HELLP syndrome]], and [[oral contraceptive pill]]
* [[Systemic lupus erythematosis]] 
* [[Antiphospholipid syndrome|Antiphospholipid antibody syndrome]]
* [[Glomerulopathy]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | ↓
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | −
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subcategory
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |History
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mucosal bleeding
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Petechia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ecchymoses
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Menorrhagia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hematoma
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemarthrosis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Plt
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PTT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Comments
|-
! align="center" style="padding: 5px 5px; background: #DCDCDC;" |Thromobcytosis
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Iron deficiency anemia|Iron deficiency anemia]]
Inflammatory diseases
 
[[Splenectomy]]
 
[[Essential thrombocytosis|Essential thrombocytosis]]
| align="left" style="background:#F5F5F5;" |
* Digital [[pain]]
* [[Gangrene]]
* [[Erythromelalgia]]
* H[[eadache]]
* [[Paresthesia|Paresthesias]] 
* [[Transient ischemic attack|Transient ischemic attacks]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl or ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | −
|-
! rowspan="6" align="center" style="padding: 5px 5px; background: #DCDCDC;" |Qualitative Disorders of [[Platelet]] Function<span name="harr_c115s002s004s001p001"></span><span name="9100803"></span>
! rowspan="4" align="center" style="padding: 5px 5px; background: #DCDCDC;" |Inherited Disorders of [[Platelet]] Function<span name="harr_c115s002s004s001p001"></span><span name="9100803"></span>
! align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Glanzmann's thrombasthenia|Glanzmann’s thrombasthenia]]
| align="left" style="background:#F5F5F5;" |
* Positive family history
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | Rare
| align="center" style="background:#F5F5F5;" | Nl or ↓
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="left" style="background:#F5F5F5;" |
* AR inheritance
* Absence of the platelet Gp IIb/IIIa receptor
* Diminished for GP 2B-3A on [[Flow cytometry|flow cytometry]]
|-
! align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Bernard-Soulier syndrome]]
| align="left" style="background:#F5F5F5;" |
* Positive family history
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | Nl or ↓
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="left" style="background:#F5F5F5;" |
* AR inheritance
* Absence of the platelet Gp Ib-IX-V receptor
* On PBS: giant platelets
* Ristocetin - no aggregation
|-
! align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Wiskott-Aldrich syndrome]]
| align="left" style="background:#F5F5F5;" |
* Positive family history
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | Nl or ↓
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="left" style="background:#F5F5F5;" |
* Anti-WASP antibody can be used to detect presence or absence of WAS protein
* In Wiskott–Aldrich syndrome, the [[Platelet|platelets]] are small and do not function properly. They are removed by the [[spleen]], which leads to low [[platelet]] counts.
|-
! align="left" style="padding: 5px 5px; background: #DCDCDC;" |Platelet storage pool disorder:
*[[Hermansky-Pudlak syndrome]]
*[[Chediak-Higashi syndrome]]
*[[Gray platelet syndrome]]
| align="left" style="background:#F5F5F5;" |
* Positive family history
* [[Hairy cell leukemia]]
* [[Cardiovascular bypass]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | Nl or ↓
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="left" style="background:#F5F5F5;" |
* AD inheritance
* AbNlities of platelet granule formation
|-
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |Acquired Disorders of [[Platelet]] Function<span name="harr_c115s002s004s002p001"></span><span name="9100808"></span>
| align="left" style="background:#F5F5F5 " |
* [[Chronic renal failure pathophysiology|Uremia]]
* [[Cardiopulmonary bypass]]
* Hematologic disorders such as: [[Myeloproliferative disease|myeloproliferative]] and [[Myelodysplastic syndrome|myelodysplastic syndromes]]
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" | Nl or ↓
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | −
|-
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Von Willebrand disease|Von Willebrand Disease]]<span name="harr_c115s002s005p001"></span><span name="9100810"></span>
| align="left" style="background:#F5F5F5;" |
* Easy bruising
* [[Epistaxis]]
* Oral cavity bleeding
* Bleeding after dental extraction/surgery
* [[Menorrhagia]]
* [[Postpartum hemorrhage]]
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | <nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | See the table below for the details about different types.
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subcategory
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |History
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mucosal bleeding
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Petechia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ecchymoses
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Menorrhagia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hematoma
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemarthrosis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Plt
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PTT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Comments
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Vessel wall disorders
! align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Metabolism|Metabolic]] and [[Inflammation|Inflammatory]] Disorders
! colspan="2" align="left" style="padding: 5px 5px; background: #DCDCDC;" |
* Acute febrile illnesses
* [[Cryoglobulinemia|Mixed cryoglobulinemia]]
* [[Monoclonal gammopathy|Monoclonal gammopathies]]
* [[Rocky Mountain spotted fever]]
* [[Vitamin C deficiency]]
* [[Cushing's syndrome|Cushing’s syndrome]]
* Chronic [[glucocorticoid]] therapy
* [[Vasculitis]] such as Henoch-Schönlein Purpura
| align="left" style="background:#F5F5F5;" |
* History of the underlying disease
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl or ↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |−
|-
! align="center" style="padding: 5px 5px; background: #DCDCDC;" |Inherited Disorders of the [[Vessel wall|Vessel Wall]]
! colspan="2" align="left" style="background:#DCDCDC;" |
* [[Marfan's syndrome|Marfan’s syndrome]]
* [[Ehlers-Danlos syndrome]]
* [[Pseudoxanthoma elasticum]]
* [[Hereditary hemorrhagic telangiectasia]] ([[Hereditary hemorrhagic telangiectasia|HHT]], or [[Osler-Weber-Rendu|Osler-Weber-Rendu disease]])
| align="left" style="background:#F5F5F5;" |
* Positive family history
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl or ↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |−
|-
! rowspan="15" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Coagulation factor disorders
<ref name="pmid28966616" />
! align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Fibrinogen]] deficiency
! colspan="2" align="left" style="padding: 5px 5px; background: #DCDCDC;" |
Different types of the [[fibrinogen]] disorders:
* [[Fibrinogen#Congenital afibrinogenemia|Congenital afibrinogenemia]]
* [[Fibrinogen#Congenital hypofibrinogenemia|Congenital hypofibrinogenemia]]
* [[Fibrinogen#Fibrinogen storage disease|Fibrinogen storage disease]]
* [[Fibrinogen#Congenital dysfibrinogenemia|Congenital dysfibrinogenemia]]
* [[Fibrinogen#Hereditary fibrinogen A.CE.B1-Chain amyloidosis|Hereditary fibrinogen Aα-Chain amyloidosis]]
* [[Fibrinogen#Acquired dysfibrinogenemia|Acquired dysfibrinogenemia]]
| align="left" style="background:#F5F5F5;" |
* [[Epistaxis]]
* Easy [[Bruise|bruising]]
* [[Menorrhagia]]
* [[Muscle]] bleeds
* [[Hemarthrosis]]
* [[Bleeding]] from the [[umbilical cord]] stump after birth
* Bleeding after [[dental surgery]] or tooth extraction
* AbNl bleeding during or after injury, surgery, or childbirth
* [[Gastrointestinal tract|Gastrointestinal]] [[hemorrhage]]
* [[Cerebral hemorrhage]]
* [[Thrombosis]]
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="left" style="background:#F5F5F5;" |
* Impaired fibrin cross-linking or clot dissolution
* Mild or severe bleeding idepend on levels of functional fibrinogen
* Variable age of onset
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subcategory
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |History
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mucosal bleeding
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Petechia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ecchymoses
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Menorrhagia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hematoma
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemarthrosis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Plt
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PTT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Comments
|-
! colspan="3" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Prothrombin deficiency]]
| align="left" style="background:#F5F5F5;" |
* [[Epistaxis]]
* Soft-tissue hemorrhage
* Excessive postoperative bleeding
* [[Menorrhagia]]
* Muscle [[Hematoma|hematomas]]
* [[Hemarthrosis]]
* [[Intracranial hemorrhage|Intracranial]] bleeding
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | Nl
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | ↑
| align="center" style="background:#F5F5F5;" | −
|-
! colspan="3" rowspan="1" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Factor V deficiency]]
| align="left" style="background:#F5F5F5;" |
* Excessive bruising with minor injuries
* [[Epistaxis]]
* [[Hemarthrosis]]
* [[Menorrhagia]]
* [[Intracerebral hemorrhage|Intracerebral hemorrhages]]
* [[Pulmonary hemorrhage]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
* The severity of bleeding related to the degree of factor V deficiency
|-
! colspan="3" rowspan="1" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Factor VII deficiency]]
| align="left" style="background:#F5F5F5;" |
* Easy [[Bruise|bruising]]
* Mucosal bleeding
* Postoperative bleeding
* [[Menorrhagia]]
* Soft tissue hematomas
* [[Thrombosis]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="left" style="background:#F5F5F5;" |
* Thrombosis in inherited factor VII deficiency
* Treatment with the administration of factor VII replacement therapy
|-
! colspan="3" rowspan="1" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Factor X deficiency]]
| align="left" style="background:#F5F5F5;" |
* Prolonged bleeding following circumcision
* Easy [[Bruise|bruising]]
* [[Hematuria]]
* [[Menorrhagia]]
* Abortion
* Postpartum hemorrhage
* Epistaxis
* Pseudotumors
* Intracranial bleeding
* Hemarthroses
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |−
|-
! colspan="3" rowspan="1" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Factor XII|Factor XII deficiency]]
| align="left" style="background:#F5F5F5;" |
* Asymptomatic
* Recurrent miscarriages
* Painful leg ulcers
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subcategory
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |History
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mucosal bleeding
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Petechia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ecchymoses
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Menorrhagia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hematoma
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemarthrosis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Plt
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PTT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Comments
|-
! colspan="3" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[High-molecular-weight kininogen|High molecular weight kininogen (HMWK)]] deficiency
| align="left" style="background:#F5F5F5;" |
* Positive family history of bleeding
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
|-
! colspan="3" rowspan="1" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Prekallikrein]] deficiency
| align="left" style="background:#F5F5F5;" |
* Positive family history of bleeding
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
|-
! rowspan="1" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Factor XIII deficiency]]
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |
* Sub unit A mutation disease (more common)
* Sub unit B mutation disease
| align="left" style="background:#F5F5F5;" |
* Positive family history of bleeding
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl or ↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="left" style="background:#F5F5F5;" |
* Impaired fibrin cross-linking or clot dissolution
* The severity of factor XIII deficiency bleeds can be different in different patients
|-
! rowspan="3" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Hemophilia]]
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |Type A deficiency
| align="left" style="background:#F5F5F5;" |
* Eeasy [[Bruise|bruising]]
* Inadequate clotting in [[trauma]] or mild injury
* Spontaneous hemorrhage
* [[Hemarthrosis]]
* [[Epistaxis]]
* [[Gingival bleeding]]
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |−
|-
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |Type B deficiency
| align="left" style="background:#F5F5F5;" |
* Neonatal bleeding
* Trauma-related soft tissue hemorrhage
* [[Hemarthrosis]] 
* [[Hematoma|Hematomas]]
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |−
|-
! colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |Type C deficiency
| align="left" style="background:#F5F5F5;" |
* Positive family history
* Bleeding after surgery or injury
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |Rare
| align="center" style="background:#F5F5F5;" |Rare
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |−
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subcategory
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |History
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mucosal bleeding
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Petechia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ecchymoses
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Menorrhagia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hematoma
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemarthrosis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Plt
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PTT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Comments
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Rare diseases
! colspan="3" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Disseminated intravascular coagulation|Disseminated Intravascular Coagulation]]
| align="left" style="background:#F5F5F5;" |
* [[Trauma]]
* [[Burn]]
* [[Crush injury]]
* [[Sepsis]]
* [[Malignancy]]
* Obstetric complication: abruption, amniotic fluid embolism
* [[Hemolytic anemia]]
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |−
|-
! colspan="3" align="center" style="padding: 5px 5px; background: #DCDCDC;" |[[Vitamin K Deficiency]]
| align="left" style="background:#F5F5F5;" |
* Bleeding after trauma
* [[Epistaxis]]
* [[Hematoma]]
* Gastrointestinal bleeding
* [[Menorrhagia]]
* [[Hematuria]]
* Gum bleeding
* Oozing from venipuncture sites
* Easy [[Bruise|bruisability]]
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl or mildly prolonged
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |−
|}
|}


Revision as of 17:06, 25 October 2018

Sepsis in Adult Patients

Diagnostic Criteria

  • SIRS
  • Sepsis
  • Severe Sepsis
  • Septic Shock

    • Causes

    Focused Initial Rapid Evaluation

    Empiric Antibiotic Therapy

    Dos

    Don'ts

    Different types of Von-Willebrand diseases

    Type of VWD Type of factor deficiency Prevalence Inheritance pattern Clinical manifestations VWF activity RIPA Factor VIII
    Type 1 Quantitative/ partial 60-70% AD
    • Bleeding severity mild to severe
    		 ↓ ↓ ↓
    Type 2 2A Qualitative 10% AD/AR ↓ ↓ N or ↓
    2B Qualitative 5% AD ↓ ↑ N or ↓
    2M Qualitative <1% AD/AR ↓ ↓ N or ↓
    2N Qualitative <1% AR N N ↓
    Type 3 Complete deficiency 1-2% AR Absent ↓ Low, 1-10%

    For more information on Von Willebrand disease, click here.

    Retrieved from "https://www.wikidoc.org/index.php?title=Sandbox:_sadaf&oldid=1499818"