Bleeding disorder resident survival guide

Bleeding disorder Resident Survival Guide
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Javaria Anwer M.D.[2]

Overview

Causes

Coagulopathy

The following are the causes of coagulopathy (defects in coagulation):

Genetic:

Hemorrhagic Disorders

• Factor VIII Deficiency
• Factor IX Deficiency
• Von Willebrand Factor Deficiency
• Factor XI Deficiency
• Factor II, V, VII, X Deficiency (Common Pathway Proteins)
• Factor XIII and Fibrinogen Deficiency

Hypercoaguable Diseases

• Antithrombin III Deficiency
• Protein C and S Deficiency

Acquired:

• Prohemorrhagic Liver Diseases
• Vitamin K Deficiency
• Drugs such as:
  • Warfarin
  • Heparin
  • Hemodilution and massive transfusion
  • Disseminated Intravascular Coagulation (DIC)
  • Immunoglobulin mediated Factor Deficiency (VIII, V, XIII, X)
  • Hyperfibrinolysis
  • Venom Induced

Prothrombotic:

• Heparin Induced Thrombocytopenia
• Antiphospholipid Antibody Syndrome
• Microvascular Thrombosis (Warfarin Induced Skin Necrosis)

Platelet Related Disorders

Congenital:

• Glanzmann's thrombasthenia
• Bernard-Soulier syndrome
• Von Willebrand's disease

Acquired

• Myeloproliferative Disorders
• Uremia
• Drugs (NSAIDs, Aspririn, Clopidogrel etc.)
• Neoplasia
• Monoclonal Gammopathies
• DIC
• Ehlrichiosis
• Retroviral Infection
• Snake Venom
• Cirrhosis

FIRE

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients with severe bleeding and in need of immediate intervention.

Boxes in red signify that an urgent management is needed Abbreviations

Boxes in red signify that an urgent management is needed.

Assess the patient for bleeding and screen with CBC, PT, aPTT ❑ Clinical assessment of types and sites of bleeding ❑ Spontaneous or follows trauma ❑ Duration of bleeding (lifelong/recent) ❑ History of blood transfusion ❑ History of bleeding after surgical procedures ❑ Drug History ❑ Family history of bleeding disorders

Soft tissue hematoma, deep internal hemoorhage, hemarthrosis

Superficial cutaneous or mucous membrane bleeding

PT Normal, aPTT Prolonged

PT Prolonged, aPTT Normal

PT Prolonged, aPTT Prolonged

Platelet Count Low

Platelet Count Normal

•Factor VIII, IX, XI Deficiency •Von Willebrand Disease •Heparin Contamination

•Factor VII deficiency •Vitamin K Deficiency

•Check Thrombin Time

•Idiopathic Thrombocytopenic Purpura (ITP) •Hereditary Platelet Disorder •Bone Marrow Failure

•Check PFA-100

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Diagnosis

Treatment

Do's

Don'ts

References