Bleeding Disorders

Dairion Gatot, Savita Handayani

Hematology -Onkology Medic Division

Internal Departement of Medical Faculty of North Sumatera
University /
Haji Adam Malik General Hospital,
Medan 2013
 What is it?
A bleeding disorder is an acquired or
inherited tendency to bleed
excessively
 Bleeding
disorders

Vascular Clotting factor

Platelet disorders
abnormalities abnormalities
 Vascular abnormalities
Causes
Henoch - Schnlein Purpura
systemic hypersensitivity disease of unknown cause
polyarthralgia, and acute Glomerulonephritis
Palpable purpuric rash, colicky abdominal pain
Infections
Meningococcemia, Rickettsioses , Infective endocarditis
Aging process senile purpura (batemans diseases)
Scurvy and the Ehlers-Danlos syndrome
Drug reactions
Cushing syndrome
Amyloid infiltration of blood vessels
Vascular abnormality
features :
Perdarahan vascular , Petechie,
Purpura,
Non palpable purpura
senile purpura
scurvy
use corticosteroid
Palpable purpura Henoch-
Schonlein syndrome
 Henoch-Schonlein purpura

20y Male, fever, painful symmetric polyarthritis for a day. During the
next two days, edema and palpable purpura developed.
Henoch-Schonlein purpura
Immune
disorder
Children
Follows
infection
Petechiae
with edema
and itching.
9 Maret 2004
Senile Purpura
 Bleeding
disorders

Vascular Clotting factor

Platelet disorders
abnormalities abnormalities
 Platelet disorders

Thrombocytopenia =Reduced platelet number

Causes
Decreased production of platelets
vitamin B12 or folic acid deficiency
aplastic anemia, leukemia
Decreased platelet survival
Immunologic or Nonimmunologic etiology
Sequestration- Hypersplenism
ameliorated by splenectomy
Dilutional
Massive transfusions
Approach to
thrombocytopenia
THROMBOCYTOPENIA

rule out pseudothrombocytopenia

SEQUESTRATION PRODUCTION DESTRUCTION

look for splenomegaly bone marrow investigation look for underlying disorders
review meds review meds
Causes of splenomegaly aplasia immune
infection infiltration auto-immune (ITP, SLE
inflammation ineffective megakaryopoiesis drugs
congestion eg. MDS infections
maligancy selective impairment of platelet allo-immune
red cell disorders production non-immune
storage diseases sepsis
DIC, TTP, HUS
hypertensive disorders of pregnancy
Platelet Disorders -
Features:
Mucocutaneous bleeding
Petechiae, Purpura, Ecchymosis.
Spontaneous bleeding after
trauma
CNS bleeding (severe, plt)
Prolonged bleeding time (BT)
Dengue Hemorrhagic fever

Platelet deficiency..
 Bleeding
disorders

Vascular Clotting factor

Platelet disorders
abnormalities abnormalities
Clotting factor abnormalities
Congenital disorders
Von Willebrand disease MC with minimal bleeding
Factor VIII Deficiency - Hemophilia A or Classic Type
Factor IX Deficiency Hemophilia B
Acquired disorders
Vit. K deficiency =Due to deficient carboxylation of factors
II, VII, IX &X
Liver disease, which decreases the synthesis of both vitamin
K-dependent and -independent clotting factors.
Oral anti-coagulants
Coumarin derivatives= warfarin inhibit Vit. K factors
Coagulation disorders:
Deficiencies of Clotting factors
Onset - delayed after trauma
Deep bleeding
Into joints - Hemarthroses
Into deep tissues Hematoma
large skin bleed Ecchymoses
Ecchymoses

(typical of
coagulation
factor disorders)
Clinical Features of Bleeding Disorders

Platelet
Coagulation
disorders
factor disorders

Skin Deep in soft

tissues
Site of bleeding Mucous membranes (joints,
muscles)
(epistaxis, gum,
vaginal, GI tract)
Petechiae Yes No
Ecchymoses (bruises) Small, superficial Large, deep
Hemarthrosis / muscle bleeding Extremely rare Common
Bleeding after cuts & scratches Yes No
Bleeding after surgery or trauma Immediate, Delayed (1-2
days),
usually mild often severe
Terima Kasih