Bleeding (Excessive)
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Overview
- Bleeding occuring spontaneously without injury, or bleeding that does not stop (with direct pressure) is abnormal.
- Abnormal bleeding can be classified into the following groups:
- Coagulation factor disorders
- Platelet disorders
- Vascular disorders
Differential Diagnosis
- Arteriovenous malformation
- Bernard-Soulier Syndrome
- Capillary wall abnormalities
- Disseminated intravascular coagulation (DIC)
- Drugs:
- NSAIDs (nonsteriodal anti-inflammatory drugs)
- Aspirin
- Warfarin
- Streptokinase
- Beta-lactamase antibiotics
- Dextran
- Urokinase
- Moxolactam
- Clopidogrel
- Eptifibatide
- Abciximab
- Tirofiban
- TNK
- tPA
- rPA
- Heparin
- Fondaparinux
- Enoxaparin
- 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 O2
- 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)
Pharmacotherapy
Acute Pharmacotherapies
- Desmopressin (DDAVP) for uremia, von Willebrand's and hemophilia
- Parenteral vitamin K (vitamin K deficiency)
- Corticosteroids (ITP, HSP)
- Tranexamic acid (liver disease)
Surgery and Device Based Therapy
- Splenectomy (ITP)
References
Acknowledgements
The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Phone:617-525-6884
List of contributors:
Suggested Reading and Key General References
Suggested Links and Web Resources
For Patients
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
