Bleeding (Excessive)
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Bleeding occurring spontaneously without injury, or bleeding that does not stop (with direct pressure) is abnormal.
Classification
Abnormal bleeding can be classified into the following groups:
- Coagulation factor disorders
- Platelet disorders
- Vascular disorders
Causes
In alphabetical order. [1] [2]
- Arteriovenous malformation
- Bernard-Soulier Syndrome
- Capillary wall abnormalities
- Disseminated intravascular coagulation (DIC)
- Drugs:
- 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 oxygen
- 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)
Acute Pharmacotherapies
- Desmopressin (DDAVP) for uremia, von Willebrand’s and hemophilia
- Parenteral vitamin K (vitamin K deficiency)
- Corticosteroids (ITP, HSP)
- Tranexamic acid (liver disease)
Contraindicated medications
Active pathological bleeding is considered an absolute contraindication to the use of the following medications:
Surgery and Device Based Therapy
References
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