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];
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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