Women with bleeding disorders: differential diagnosis.45
| . | Coagulation Disorders . | Platelet Disorders . | Vessel Wall Disorders . |
|---|---|---|---|
| Congenital | |||
| Hemophilia A, B carrier | von Willebrand disease | Hereditary hemorrhagic telangiectasia | |
| Factor XI deficiency | Bernard-Soulier syndrome | Ehlers-Danlos syndrome | |
| Other factor deficiencies | Glanzmann thromboasthenia | ||
| Storage pool disease | |||
| Acquired | |||
| Acquired anti-VIII inhibitor | ITP | Physical: valsalva, weight-lifting | |
| Vitamin K deficiency | TTP | Infection: bacterial, viral, rickettsial | |
| Liver disease | Drug: ASA, NSAIDs, antibiotics, chemotherapy | Drug: heparin necrosis coumadin necrosis | |
| DIC | |||
| Drug: coumadin, heparin, antibiotics | Collagen diseases: SLE | Dysproteinemias | |
| Chronic renal disease | Cutaneous vasculitis | ||
| Leukemias | |||
| Myeloproliferative disorders | |||
| . | Coagulation Disorders . | Platelet Disorders . | Vessel Wall Disorders . |
|---|---|---|---|
| Congenital | |||
| Hemophilia A, B carrier | von Willebrand disease | Hereditary hemorrhagic telangiectasia | |
| Factor XI deficiency | Bernard-Soulier syndrome | Ehlers-Danlos syndrome | |
| Other factor deficiencies | Glanzmann thromboasthenia | ||
| Storage pool disease | |||
| Acquired | |||
| Acquired anti-VIII inhibitor | ITP | Physical: valsalva, weight-lifting | |
| Vitamin K deficiency | TTP | Infection: bacterial, viral, rickettsial | |
| Liver disease | Drug: ASA, NSAIDs, antibiotics, chemotherapy | Drug: heparin necrosis coumadin necrosis | |
| DIC | |||
| Drug: coumadin, heparin, antibiotics | Collagen diseases: SLE | Dysproteinemias | |
| Chronic renal disease | Cutaneous vasculitis | ||
| Leukemias | |||
| Myeloproliferative disorders | |||
| Clinical Bleeding History . |
|---|
| Adapted from reference 45 |
| Abbreviations: ITP, immune thrombocytopenic purpura; TTP, thrombotic thrombocytopenic purpura; ASA, aspirin; NSAIDS, nonsteroidal anti-inflammatory drugs; SLE, systemic lupus erythematosus; DIC, disseminated intravascular coagulation |
| Components of a Clinical Bleeding History |
| Age at first bleeding symptoms |
| Frequency, severity |
| Requirement for transfusion |
| Spontaneous vs. traumatic bleed |
| Postoperative bleeding |
| Family members affected, sex-linked |
| Medication history |
| Types of Bleeding |
| 1. Mucosal bleeding |
| Defect: Platelet plug formation or “primary hemostasis” |
| Symptoms: Menorrhagia, epistaxis, bruising, postoperative, dental, gastrointestinal, genito-urinary bleeding |
| 2. Body cavity bleeding |
| Defect: Fibrin clot formation or “secondary hemostasis” |
| Symptoms: Hemarthroses, hematomas, postoperative, retroperitoneal, central nervous system bleeding |
| 3. Petechiae, ecchymoses, purpura |
| Defect: Vessel wall abnormality |
| Symptoms: Telangiectasia, gravity-dependent lesions, palpable vs. nonpalpable |
| Clinical Bleeding History . |
|---|
| Adapted from reference 45 |
| Abbreviations: ITP, immune thrombocytopenic purpura; TTP, thrombotic thrombocytopenic purpura; ASA, aspirin; NSAIDS, nonsteroidal anti-inflammatory drugs; SLE, systemic lupus erythematosus; DIC, disseminated intravascular coagulation |
| Components of a Clinical Bleeding History |
| Age at first bleeding symptoms |
| Frequency, severity |
| Requirement for transfusion |
| Spontaneous vs. traumatic bleed |
| Postoperative bleeding |
| Family members affected, sex-linked |
| Medication history |
| Types of Bleeding |
| 1. Mucosal bleeding |
| Defect: Platelet plug formation or “primary hemostasis” |
| Symptoms: Menorrhagia, epistaxis, bruising, postoperative, dental, gastrointestinal, genito-urinary bleeding |
| 2. Body cavity bleeding |
| Defect: Fibrin clot formation or “secondary hemostasis” |
| Symptoms: Hemarthroses, hematomas, postoperative, retroperitoneal, central nervous system bleeding |
| 3. Petechiae, ecchymoses, purpura |
| Defect: Vessel wall abnormality |
| Symptoms: Telangiectasia, gravity-dependent lesions, palpable vs. nonpalpable |