ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Clinical Considerations In Primary Hemorraghic Disorders And Hemostasis

Updated on February 4, 2014

Hemorrhagic Disorders

In general, primary hemorrhagic disorders are rare, in majority of cases, abnormal bleeding is due to secondary causes, either localized (surgical conditions) or generalized, e.g, hepatic failure, renal failure, anticoagulant overdose, etc.
In general, primary hemorrhagic disorders are rare, in majority of cases, abnormal bleeding is due to secondary causes, either localized (surgical conditions) or generalized, e.g, hepatic failure, renal failure, anticoagulant overdose, etc. | Source

A General Overview

In general, primary hemorrhagic disorders are rare, in majority of cases, abnormal bleeding is due to secondary causes, either localized (surgical conditions) or generalized, e.g, hepatic failure, renal failure, anticoagulant overdose, etc. In any patient who gives a history of easy bruising or excessive bledding from childhood, a congenital hemostatic defect is likely. The acquired form starts at a later stage.

Congenital hemorrhagic disorders are characterized by:

  1. Ecchymosis, hematoma or spontaneous bleeding from multiple sites of following minor trauma.
  2. Excessive bleeding after trauma or minor surgery.
  3. Bleeding into joints, gums and mucous membranes of the gastrointestinal and the genitor-urinary tracts.
  4. History of previous episodes of hospitalization and blood transfusions to control the hemorrhage.
  5. Abnormality involving one or only a few coagulant factors.

On the other hand, acquired hemorrhagic tendencies set in at a later age may be temporary and may reveal deficiencies of multiple coagulation factors.

Palpable Purpuric Lesions

These effect the process of primary hemostasis, i.e. platelet and/or vascular functions are abnormal. These are characterized by bruising, ecchymosis and bleeding from mucous membranes, especially of the gastrointestinal and genitor-urinary tracts
These effect the process of primary hemostasis, i.e. platelet and/or vascular functions are abnormal. These are characterized by bruising, ecchymosis and bleeding from mucous membranes, especially of the gastrointestinal and genitor-urinary tracts | Source

Classification of hemorrhagic disorders

Broadly, the hemorrhagic disorders can be divided into two undermentioned groups

Purpuric disorders: These effect the process of primary hemostasis, i.e. platelet and/or vascular functions are abnormal. These are characterized by bruising, ecchymosis and bleeding from mucous membranes, especially of the gastrointestinal and genitor-urinary tracts. Bleeding starts soon after injury and it is brisk initially. It is relieved by local pressure. The capillary resistance test (Hess test) is positive. Bleeding time is prolonged. Unless there is severe thrombocytopenia (less than 10000/cmm), coagulation time is not prolonged.

Coagulation defects: These may be congenital or acquired. In majority of cases, the primary coagulation disorders are congenital. They are characterized by deep tissue bleeding, into joints, progressive deformity of joints, prolonged coagulation time and normal bleeding time and a positive Hess test. If the platelets and capillaries are normal, post-traumatic bleeding stops temporarily to be followed by prolonged and gradually increasing bleeding, which may even threaten life.

Laboratory investigations in hemorrhagic disorders

Screening tests: Such as platelet count, prothrombin time (to test the extrinsic coagulation pathway) and partial thromboplastin time (to test the intrinsic coagulation pathway).

A stained blood film should show clumped and single platelets at the rate of 1 for 20-25 erythrocytes. Absence of clumping may suggest thrombasthenia.

Conclusion

The nature of the defect and therefore the most appropriate initial investigations may be suggested by the history and examination, e.g family history, intercurrent disease, alcohol consumption and drugs. Vascular/platelet bleeding is characterized by bruising of the skin and bleeding from mucosal membranes. Bleeding into the skin is manifest as petechiae (small capillary hemorrhages, a few millimeters in diameter) and superficial ecchymoses (larger areas of bleeding).

© 2014 Funom Theophilus Makama

Comments

    0 of 8192 characters used
    Post Comment

    No comments yet.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)