bleeding diathesis

{{Short description|High tendency to bleed due to a blood clotting disorder}}

{{Infobox medical condition (new)

| name = Bleeding diathesis

| synonyms = Haemorrhagic diathesis, Hemorrhagic diathesis

| image = Bleeding finger.jpg

| caption = A bleeding wound in the finger

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In medicine (hematology), bleeding diathesis is an unusual susceptibility to bleed (hemorrhage) mostly due to hypocoagulability (a condition of irregular and slow blood clotting), in turn caused by a coagulopathy (a defect in the system of coagulation). Therefore, this may result in the reduction of platelets being produced and leads to excessive bleeding.{{Cite news|url=https://www.doctorshealthpress.com/general-health-articles/bleeding-diathesis/|title=Bleeding Diathesis: Causes, Symptoms, and Treatments|date=2017-06-23|work=Doctors Health Press - Daily Free Health Articles and Natural Health Advice|access-date=2018-09-17|language=en-US}} Several types of coagulopathy are distinguished, ranging from mild to lethal. Coagulopathy can be caused by thinning of the skin (Cushing's syndrome), such that the skin is weakened and is bruised easily and frequently without any trauma or injury to the body.{{cite journal |last= Douglas |first= Hubble | name-list-style = vanc |title=Cushing' Syndrome and Thymic Carcinoma |journal=QJM: An International Journal of Medicine |date=April 1949 |volume=18 |issue=2 | pages = 133–147 |doi=10.1093/oxfordjournals.qjmed.a066529 }} Also, coagulopathy can be contributed by impaired wound healing or impaired clot formation.{{cite book | vauthors = Amin C, Sharathkumar A, Griest A | title = Neurologic Aspects of Systemic Disease Part II | chapter = Bleeding diathesis and hemophilias | series = Handbook of Clinical Neurology | volume = 120 | pages = 1045–59 | date = 2014-01-01 | pmid = 24365370 | doi = 10.1016/B978-0-7020-4087-0.00070-X | isbn = 9780702040870 }}

Signs and symptoms

class="wikitable"

! Symptom !! Disorders

Petechiae (red spots)

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  • Wiskott–Aldrich syndrome, where they may resemble a few bruises[http://www.primaryimmune.org/publications/book_pats/e_ch07.pdf Wiskott–Aldrich Syndrome] {{Webarchive|url=https://web.archive.org/web/20101221144403/http://primaryimmune.org/publications/book_pats/e_ch07.pdf |date=2010-12-21 }} The International Patient Organisation for Primary Immunodeficiencies (IPOPI).
  • Acute leukemia[https://books.google.com/books?id=d2bQQr3A-iMC 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
  • Chronic leukemia
  • Vitamin K deficiency[http://emedicine.medscape.com/article/126354-overview Vitamin K Deficiency] eMedicine. Author: Pankaj Patel, MD. Coauthor(s): Mageda Mikhail, MD, Assistant Professor. Updated: Dec 18, 2008
Purpura and ecchymoses

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  • Acute leukemia
  • Chronic leukemia
  • Vitamin K deficiency
Blood in stool

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Bleeding gingiva (gums)

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  • Wiskott–Aldrich syndrome
  • Acute leukemia
  • Chronic leukemia
Prolonged nose bleeds

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  • Wiskott–Aldrich syndrome

=Complications=

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

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! Complication !! Disorders

Soft tissue bleeding, e.g. deep-muscle bleeding, leading to swelling, numbness or pain of a limb.

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  • Hemophilia[http://www.mayoclinic.com/health/hemophilia/DS00218/DSECTION=complications Hemophilia Complications] By Mayo Clinic staff. May 16, 2009
  • Von Willebrand disease
Joint damage, potentially with severe pain and even destruction of the joint and development of arthritis

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Retinal bleeding

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  • Acute leukemia
Transfusion transmitted infection, from blood transfusions that are given as treatment.

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  • Hemophilia
Adverse reactions to clotting factor treatment.

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  • Hemophilia
Anemia

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  • Von Willebrand disease[http://www.mayoclinic.com/health/von-willebrand-disease/DS00903/DSECTION=complications Von Willebrand disease --> Complications] By Mayo Clinic staff. Feb. 7, 2009
Exsanguination (bleeding to death)

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Cerebral hemorrhage

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Causes

While there are several possible causes, they generally result in excessive bleeding and a lack of clotting.{{citation needed|date=April 2022}}

= Acquired =

Acquired causes of coagulopathy include anticoagulation with warfarin, liver failure, vitamin K deficiency and disseminated intravascular coagulation. Additionally, the hemotoxic 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.{{citation needed|date=July 2020}}

= 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.{{citation needed|date=July 2020}}

=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.{{citation needed|date=November 2021}}

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. Gene therapy treatments may be a solution as they involve in the insertion of normal genes to replace defective genes causing for the genetic disorder. Gene therapy is a source of active research that hold promise for the future.{{cite journal | vauthors = McCain J | title = The future of gene therapy | journal = Biotechnology Healthcare | volume = 2 | issue = 3 | pages = 52–60 | date = June 2005 | pmid = 23393464 | pmc = 3564347 }}

Diagnosis

=Comparing coagulation tests=

class="wikitable sortable"

|+ 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

Hemophilia

| 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

Consult a hematologist and have regular blood check ups. Have an early diagnostic test for any blood disorders or blood diseases including hemophilia, hemorrhage, and sickle-cell anemia. Prothrombin time and partial thromboplastin time blood tests are useful to investigate the reason behind the excessive bleeding. The PT evaluates coagulation factors I, II, V, VII and X, while the PTT evaluates coagulation factors I, II, V, VIII, IX, X, XI and XII. The analysis of both tests thus helps to diagnose certain disorders.{{Cite web|url=https://www.walkinlab.com/prothrombintime-pt-winrandpartialthrombopla.html|title=Prothrombin Time (PT) w/INR and Partial Thromboplastin Time (PTT) Blood Test|website=Walk-In Lab|language=en|access-date=2018-09-17}}

Blood transfusion involves the transfer of plasma containing all the necessary coagulating factors (fibrinogen, prothrombin, thromboplastin) to help restore them and to improve the immune defense of the patient after excessive blood loss. Blood transfusion also caused the transfer of platelets that can work along with coagulating factors for blood clotting to commence.{{Cite web|url=https://iliveok.com/health/hemorrhagic-diathesis_109599i15942.html|title=Hemorrhagic diathesis: causes, symptoms, diagnosis, treatment {{!}} Competently about health on iLive|website=iliveok.com|access-date=2018-09-17}}

Different drugs can be prescribed depending on the type of disease. Vitamins (K, P and C) are essential in case of obstruction to walls of blood vessels. Also, vitamin K is required for the production of blood clotting factors, hence the injection of vitamin K (phytomenadione) is recommended to boost blood clotting.{{Cite news|url=https://www.netdoctor.co.uk/medicines/heart-blood/a25886/treatments-for-bleeding-disorders/|title=Treatments for bleeding disorders|date=2015-11-03|work=Netdoctor|access-date=2018-09-17|language=en-GB}}

References

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