Bleeding diathesis

Bleeding diathesis
Classification and external resources
Specialty hematology
ICD-10 D69.9
ICD-9-CM 287.9
DiseasesDB 1442
MeSH D006474

In medicine (hematology), bleeding diathesis (h(a)emorrhagic diathesis) is an unusual susceptibility to bleed (hemorrhage) mostly due to hypocoagulability, in turn caused by a coagulopathy (a defect in the system of coagulation). Several types are distinguished, ranging from mild to lethal. Also, bleeding diathesis can be caused by thinning of the skin or impaired wound healing.[1]

Symptoms

Symptom Disorders
Petechiae (red spots)
Purpura and ecchymoses
  • Acute leukemia[3]
  • Chronic leukemia[3]
  • Vitamin K deficiency[4]
Blood in stool
Bleeding gingiva (gums)
  • Wiskott-Aldrich syndrome[2]
  • Acute leukemia[3]
  • Chronic leukemia[3]
Prolonged nose bleeds
  • Wiskott-Aldrich syndrome[2]

Causes

While there are several possible causes, they generally result in excessive bleeding and a lack of clotting.

Acquired

Acquired causes of coagulopathy include anticoagulation with warfarin, liver failure, Vitamin K deficiency and disseminated intravascular coagulation.Additionally, the haemotoxic venom from certain species of snakes can cause this condition, for example Bothrops, rattlesnakes and other species of viper. Viral hemorrhagic fevers include dengue hemorrhagic fever and Dengue Shock Syndrome

Leukemia may also cause coagulopathy. Furthermore, cystic fibrosis has been known to cause bleeding diathesis, especially in undiagnosed infants, due to malabsorption of fat soluble vitamins like Vitamin K.

Autoimmune causes of acquired coagulation disorders

There are autoimmune causes of coagulation disorders. They include acquired antibodies to coagulation factors, termed inhibitors of coagulation. The main inhibitor is directed against clotting Factor VIII. Another example is antiphospholipid syndrome an autoimmune, hypercoagulable state.

Causes other than coagulation

Bleeding diathesis may also be caused by impaired wound healing (as in scurvy), or by thinning of the skin, such as in Cushing's syndrome .

Genetic

Some people lack genes that typically produce the protein coagulation factors that allow normal clotting. Various types of Hemophilia and von Willebrand disease are the major genetic disorders associated with coagulopathy.Rare examples are Bernard-Soulier syndrome, Wiskott-Aldrich syndrome and Glanzmann's thrombasthenia.

Diagnosis

Comparing coagulation tests

Laboratory findings in various platelet and coagulation disorders
Condition Prothrombin time Partial thromboplastin time Bleeding time Platelet count
Vitamin K deficiency or warfarin Prolonged Normal or mildly prolonged Unaffected Unaffected
Disseminated intravascular coagulation Prolonged Prolonged Prolonged Decreased
Von Willebrand disease Unaffected Prolonged or unaffected Prolonged Unaffected
Haemophilia Unaffected Prolonged Unaffected Unaffected
Aspirin Unaffected Unaffected Prolonged Unaffected
Thrombocytopenia Unaffected Unaffected Prolonged Decreased
Liver failure, early Prolonged Unaffected Unaffected Unaffected
Liver failure, end-stage Prolonged Prolonged Prolonged Decreased
Uremia Unaffected Unaffected Prolonged Unaffected
Congenital afibrinogenemia Prolonged Prolonged Prolonged Unaffected
Factor V deficiency Prolonged Prolonged Unaffected Unaffected
Factor X deficiency as seen in amyloid purpura Prolonged Prolonged Unaffected Unaffected
Glanzmann's thrombasthenia Unaffected Unaffected Prolonged Unaffected
Bernard-Soulier syndrome Unaffected Unaffected Prolonged Decreased or unaffected
Factor XII deficiency Unaffected Prolonged Unaffected Unaffected
C1INH deficiency Unaffected Shortened Unaffected Unaffected

Treatments

Complications

Following are some complications of coagulopathies, some of them caused by their treatments:

Complication Disorders
Soft tissue bleeding, e.g. deep-muscle bleeding, leading to swelling, numbness or pain of a limb.
Joint damage, potentially with severe pain and even destruction of the joint and development of arthritis
Retinal bleeding
  • Acute leukemia[3]
Transfusion transmitted infection, from blood transfusions that are given as treatment.
Adverse reactions to clotting factor treatment.
Anemia
Exsanguination (bleeding to death)
Cerebral hemorrhage

References

  1. ↑ Amin, Chirag; Sharathkumar, Anjali; Griest, Anne (2014-01-01). "Bleeding diathesis and hemophilias". Handbook of Clinical Neurology. 120: 1045–1059. doi:10.1016/B978-0-7020-4087-0.00070-X. ISSN 0072-9752. PMID 24365370.
  2. 1 2 3 4 5 Wiskott-Aldrich Syndrome The International Patient Organisation for Primary Immunodeficiencies (IPOPI).
  3. 1 2 3 4 5 6 7 8 9 Disorders of thrombosis and hemostasis: clinical and laboratory practice. Page Rodger L. Bick. Edition 3, illustrated. ISBN 0-397-51690-8, ISBN 978-0-397-51690-2. 446 pages
  4. 1 2 3 Vitamin K Deficiency eMedicine. Author: Pankaj Patel, MD. Coauthor(s): Mageda Mikhail, MD, Assistant Professor. Updated: Dec 18, 2008
  5. 1 2 3 4 Hemophilia Complications By Mayo Clinic staff. May 16, 2009
  6. 1 2 3 4 Von Willebrand disease --> Complications By Mayo Clinic staff. Feb. 7, 2009
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