Main clinical manifestations of a bleeding diathesis: an often disregarded aspect of medical and surgical history taking

Abstract

A suitable clinical evaluation of a bleeding diathesis is often forgone. The young doctor is often unprepared to describe in an accurate way the different types of bleeding. An adequate classification and adequate clinical information about a bleeding diathesis are instead of paramount importance. Bleeding may be cutaneous, mucous, articular, muscular, parenchymal, intracavitary, orificial. Each of these sites and forms may have diagnostic implications. An accurate description of the several forms of cutaneous bleeding (petechiae, purpuric spots, ecchymosis, haematomas, etc.) is needed for referrals and for controls. The correct evaluation of cutaneous bleeding manifestations of children (battered child syndrome) is absolutely important for clinical and medico-legal purposes. The same is true for the battering syndrome seen in women abused by their spouses. The grading of haemarthrosis in haemophilia patients is important for the follow-up. A proper description of haematuria is essential in suggesting the probable site of bleeding (kidney or bladder or urethra). A proper evaluation of bleeding may give also useful information on the general health status of the patients (presence of anaemia, poor nutrition, renal insufficiency, etc.). The combination of bleeding and thrombosis in the same patient is also a clinical challenge. The relationship between haemorrhage and thrombosis may be sequential or concomitant. Sequential thrombosis may occur in a patient confined in bed for a brain haemorrhage. Concomitant thrombosis and bleeding occur in DIC and in patients with thrombosis being treated with anticoagulants. Finally, it should be kept in mind that a proper evaluation of the bleeding diathesis of a given patient may help the caring doctor in ordering appropriate laboratory tests (e.g. a platelet count for petechiae, a PTT for a patient with haemarthrosis, etc.).

Acute abdomen in a patient with haemophilia A: A case study

“…The complications may include retroperitoneal hematoma, hematoma of the intestinal loops or hematoma of the abdominal musculature [7,8,14]. These complications may arise spontaneously or after minor trauma, simulating an acute abdomen [9].…”

“…Hemophilia A and B are hereditary disease that result from functional deficiencies in specific circulating blood clotting factors termed factor VIII and factor IX [7]. The gene for factor VIII is located on the X chromosome and is relatively large.…”

Hemofilija a Ir B Sergančių Lietuvos Vaikų Burnos Sveikata Ir Ją Lemiantys Veiksniai

“…Ši liga vienodai paplitusi įvairiose etninėse, socialinėse ir ekonominėse grupėse [1]. Hemofilijos A (HA) dažnis siekia 1:5000-10 000 gyvų gimusių berniukų, o hemofilija B (HB) diagnozuojama 1 iš 30 000-50 000 [3,4]. VU Santariškių klinikų filialo vaikų ligoninės Onkohematologijos centro duomenimis, kasmet Lietuvoje diagnozuojama nuo 1 iki 3 naujų hemofilijos atvejų.…”

“…Net dantų valymas ar kieto maisto kramtymas gali sukelti dantenų kraujavimą, todėl HSA vengia valytis dantis, jų burnos higiena dažnai yra nepilnavertė [8]. Problemą kelia ir tai, kad gydytojai odontologai neturi arba kartais turi labai menką HSA dantų gydymo patirtį ir, bijodami galimų gydymo komplikacijų, vengia gydyti sergančiuosius hemofilija [3,8,9]. Nepakankama burnos higiena ir laiku nepradėtas odontologinis gydymas lemia ėduonies, gingivito, periodontito ar periostito išsivystymą, tai labai padidina invazyvaus odontologinio gydymo poreikį ir kraujavimo tikimybę [10].…”

“Why Did My CPAP Beat Me Up?” Bilateral Periorbital Ecchymosis Associated with Continuous Positive Airway Pressure Therapy

“…Ecchymosis is an area of blood extravasation larger than 5 mm in size and is usually secondary to small or medium sized blood vessel trauma. 3 In patients with either congenital or acquired coagulation defects, even trivial trauma may result in ecchymosis. Petechial hemorrhages are smaller (< 2 mm) and typically due to damage to dermal capillaries.…”