Bleeding diathesis

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Bleeding diathesis main page

Overview

Classification

Differential Diagnosis

Platelet disorders
Immune Thrombocytopenic Purpura
Thrombotic Thrombocytopenic Purpura
Hemolytic Uremic Syndrome
Thrombocytosis
Von Willebrand Disease
Coagulation disorders
Fibrinogen deficiency
Prothrombin deficiency
Factor V deficiency
Factor VII deficiency
Factor VIII deficiency
Factor IX deficiency
Factor X deficiency
Factor XI deficiency
Factor XII deficiency
High-molecular-weight kininogen deficiency
Prekallikrein deficiency
Factor XIII deficiency
Hemophilia
Rare diseases
Disseminated Intravascular Coagulation
Vitamin K Deficiency

Different types of Von-Willebrand diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mehrian Jafarizade, M.D [2], Nazia Fuad M.D.

Overview

Bleeding diathesis is unusual susceptibility to bleed due to hypo-coagulopathies. These diseases can occur due to a disorder of homeostasis, localized process (tissue injury), or medications. Bleeding diathesis can be resulted from vessel wall injury, platelet disorders, and coagulation factor disorders. Clinical manifestation of bleeding disorders can have a wide range of symptoms from asymptomatic to symptomatic massive and life threatening bleeding. Platelet disorders mostly have skin manifestations such as petechiae, and ecchymoses. In order to find the cause of hypo-coagulopathy, there are established laboratory tests that might be used. These laboratory tests such as peripheral blood smear, platelet count and platelet function analysis, coagulation factor deficiencies and inhibitors, fibrinolysis tests (eg. D-dimer level), bleeding time, prothrombin time, activated partial thromboplastin time, thrombin time and reptilase time.

Classification

Differential Diagnosis

Category Sub-category Diseases History Clinical manifestation Laboratory testing Comments
Petechiae Ecchymoses Menorrhagia Hematomas Hemarthrosis platelet count Bleeding time (BT) Prothrombin time (PT) Platelet count activated partial thromboplastin time (aPTT) Thrombin time (TT)
Platelet disorders Thrombocytopenia Infection-Induced Thrombocytopenia + + N N
Medications-Induced Thrombocytopenia History of medications + + N N
Heparin-Induced Thrombocytopenia
  • Trombosis
  • Unexplained thrombocytopenia up to 3 weeks after the end of heparin therapy
+ +
Immune Thrombocytopenic Purpura (ITP) + + N N
Inherited Thrombocytopenia N N
Thrombotic Thrombocytopenic Purpura (TTP)
Hemolytic Uremic Syndrome N N
Thromobcytosis + + ɴormal or slightly prolonged ɴ ɴ
Qualitative Disorders of Platelet Function Inherited Disorders of Platelet Function
Acquired Disorders of Platelet Function
Von Willebrand Disease + + + + + Ν
Vessel wall disorders Metabolic and Inflammatory Disorders
Inherited Disorders of the Vessel Wall
Coagulation disorders Fibrinogen deficiency
Prothrombin deficiency
Factor V deficiency
Factor VII deficiency
Factor X deficiency
Factor XII deficiency
HK deficiency
Prekallikrein deficiency
Factor XIII deficiency
Hemophilia Type A deficiency
  • Eeasy bruising
  • Inadequate clotting in trauma or mild injury
  • Spontaneous hemorrhage.
  • Hemarthrosis
  • Epistaxis
  • Gingival bleeding
_ _ + + + Unaffected Unaffected Unaffected Prolonged N
Type B deficiency
  • Neonatal bleeding
  • Trauma-related soft-tissue hemorrhage
  • Hemarthrosis
  • Hematomas
_ _ + + + Unaffected N N N
Type C deficiency
  • Family history of bleeding disorder,
  • Bleeding after surgry or injury
_ _ + Rare Rare N N N N
Rare diseases Disseminated Intravascular Coagulation
  • Trauma
  • Burn
  • Crush injury
  • Sepsis
  • Malignancy
  • Obstetric complication: abruption, amniotic fluid embolism
  • Hemolytic anemia
+ + _ + +
Vitamin K Deficiency
  • Bleeding after trauma
  • Epistaxis
  • Hematoma
  • Gastrointestinal bleeding,
  • Menorrhagia
  • Hematuria
  • Gum bleeding
  • Oozing from venipuncture sites
  • Easy bruisability
+ + + + + N Normal or mildly prolonged
Coagulation Disorders Associated with Liver Failure
Acquired Inhibitors of Coagulation Factors

Different types of Von willebrand diseases can be differentiate from each other based on below table:

Type of VWD Type of factor deficiency Prevalence Inheritance pattern Clinical manifestations VWF activity RIPA Factor VIII Plt levels
type 1 Quantitative/ partial