Approach to bleeding
|
|
- Katrina Page
- 5 years ago
- Views:
Transcription
1 Approach to bleeding By Assoc. Prof. Darintr Sosothikul, MD Pediatric Hematology-Oncology division, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University
2 The mechanism of hemostasis Blood vessel Platelet Blood flow Coagulation adhesion VWF aggregation activation Fibrin IIa IIase Xase FVIIa TF Subendothelial matrix Vessel injury Hemostatic plug Courtesy of Dr Shima 2
3 Primary Hemostasis Stable Platelet adhesion/ Platelet Rolling: GPIb/VWF GPVI+α2β1/collagen activation/aggregation: GPIIb/IIIa Blood Flow Platelet adhesion: GPIb/VWF VWF VWF collagen VWF VWF collagen VWF collagen VWF collagen WHF
4 Platelet Binding site for vwf GpI X GpIb Open canalicular system Mitochondrion GpIIb/IIIa Binding site for Fibrinogen and vwf Lysosome Alpha-granules Fibrinogen,vWF,PDGF, PF4 and P-selectin Glycogen Dense bodies ADP,ATP,ionized calcium and serotonin Microtubules
5 Cell-based Model 2000S VIII/VWF- VIIIa V-Va XI-XIa platelet Two main functions of TF to activate factor X to Xa to activate factor IX to IXa Hoffman M, Monroe DM Thromb Haemost 2001: Robert HR,et al Anesthesiology 2004:722-30
6 Cell-based Model 2000S Thrombin Hoffman M, Monroe DM Thromb Haemost 2001: Robert HR,et al Anesthesiology 2004:722-30
7 Fibrinolytic system tpa: tissue plasminogen activator PAI-1: Plasminogen activator inhibitor Adapted from Wiman MFR 1987
8 Control Mechanisms 1) TF pathway inhibitor 2) Protein CS system 3) Antithrombin 4) Glycoaminoglycans APC: activated protein C AT: antithrombin GAG: glycoaminoglycans T: thrombin PC: protein C S: protein S TF: tissue factor TM: thrombomodulin
9 Approach to the Bleeding patient Detailed history Is a bleeding tendency present? Is the condition familial or acquired? Is the disorder affecting primary or secondary hemostasis? Is there underlying systemic disease causing or exacerbating the bleeding tendency? Is the increased bleeding pharmacologically induced?
10 Patterns of Clinical Bleeding in Disorders of Hemostasis Characteristic Onset of bleeding Sites of bleeding Skin Mucous membranes Other sites Disorders of 1º Hemostasis ( Platelet-Vascular) Spontaneous or immediately after trauma Superficial surfaces Petechiae, ecchymosis Common (Oral, nasal) Rare Disorders of 2º Hemostasis ( Coagulation Factor) Delayed after trauma Deep tissues Hematomas Rare Common (joint,muscle) Bleeding stop after pressure Yes No
11 Congenital coagulopathies and Qualitative thrombocytopathies Sex-Linked Recessive Hemophilia A (factor VIII deficiency) Hemophilia B (factor IX deficiency) Wiskott-Aldrich syndrome Autosomal Dominant von Willebrand Disease Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia) Dysfibrinogenemias Autosomal Recessive Disorders Deficiencies in factor II, V, VII, XI, X, or XIII α2-antiplasmin deficiency Bernard-Soulier syndrome Glanzmann s thrombasthenia Gray platelet syndrome Afibrinogenemia Hypofibrinogenemia Type 3 von Willebrand disease
12 Platelet / Vascular defect Mucocutaneous bleeding
13 Coagulation defect CNS bleeding/ deep tissue or hemarthrosis
14 Purpura fulminans
15 Laboratory evaluation; screening tests CBC: quantitative assessment of platelets Bleeding time Prothrombin time (PT) assay and INR Activated partial thromboplastin time (aptt) Thrombin time or Fibrinogen level Small size of platelet Normal size of platelet Giant platelet
16 Pre-analytic errors Problems with blue-top Biological effects tube Hct > 55% or < 15% Partial fill tubes Lipidemia Vacuum leak and citrate Hyperbilirubinemia evaporation Hemolysis Problem with phlebotomy Laboratory errors Heparin contamination Delayed in testing Slow fill Prolonged incubation at 37C Vigorous shaking Freeze/Thaw deterioration
17 Developmental hemostasis Contact factors: XII, X, HMWK and vitamin K dependent: FII, VII, IX, X are decreased until 6 months of age Thrombin generation is decreased 30 50% compared with adult levels Neonatal platelets are to be hyporeactive to thrombin, ADP, epinephrine, and TXA 2 due a defect intrinsic to neonatal platelets Kids are not little adults: the differences Andrew M,et al. Blood 1992;80(8): Massicotte MP, et al.thromb Res 2006;118(1): Rajasekhar D, et al Thromb Haemost 1997;77(5):1002 7
18 Pediatric reference values for molecular markers in hemostasis Sosothikul D, Seksarn P, Lusher JM. J Pediatr Hematol Oncol :19-22
19
20 Mixing study A 1:1 mixing study is done when the PT/PTT is prolonged. The patient's plasma is mixed with normal plasma and the abnormal test is repeated. If the mixing of normal plasma corrects the abnormal test, then a factor deficiency is suggested; otherwise, an inhibitor is suspected.
21 Case study A 5-year-old girl presents with multiple large ecchymoses on both arms and legs. No family history of bleeding tendency PE shows many dental caries with gum bleeding. Otherwise are normal.
22 Laboratory investigation Case study CBC: Hb 12.5 g/dl MCV 82 Fl, MCH 29 pg, MCHC 33%,RDW 12%, WBC 12,300 / µl (N56,L12,E32%) and Platelet 250,000/ µl
23 Laboratory investigation What further investigations are required for definite diagnosis? Bleeding time 14 min Platelet aggregation test Stool exam for parasites: ascaris eggs
24 Platelet Aggregation Test ADP Collagen
25 PLATELET Platelet Gplb/IX vwf ADHESION DISORDERS vwd Bernard-Soulier syr. ADP TXA Platelet release defect Storage pool disease RELEASE Platelet GplIb/IIIa Fibrinogen AGGREGATION Glanzmann s thrombasthemia
26 Acquired platelet dysfunction with eosinophilia (APDE) acquired platelet function defect It was first described by Mitrakul and Suvatte in Unknown etiology. It has been speculated that the high IgE is in response to parasite causes mediated mast cell degranulation and leads to in-vivo platelet activation. Platelet function tests show variable storage pool defects.
27 Clinical manifestations Spontaneous bruising on the extremities off and on for a duration of weeks or months The purpura is shown as purpuric spots or medium size ecchymoses. Mucosal bleeding eg. epistaxis, gum bleeding No spontaneous intracranial hemorrhage. Bleeding symptoms in most patient are mild, transient with spontaneous recovery.
28 APDE: management Spontaneous recovery within 6 months. Avoid trauma and injury; identification card Transfusion of platelet concentrate are given only when undergoing surgery. Reassure the parent about the prognosis and alert them to accidents. Common intestinal parasites are usually removed by giving antihelminthic drugs.
29 Case study A full- term neonate male presented with seizure and pale PE: Marked pale conjuctivae,tense anterior fontanalle and cephalhematoma
30 Pedigree
31 Case study What further investigations are indicated? CBC: Hb 7.5 g/dl, Hct 22%, MCV 100 fl. WBC 12,500 (N55,L40,Mo5) and platelets 300,000/µl Coagulogram: PT 12 s (c s) aptt 90 s (c s) and TT 11 (c s) Factor VIII < 1 %
32 CT brain: Case study
33 Case study How would you treat this patient? Factor VIII replacement: Factor VIII conc 50 units/kg every 8-12 hr, LD-PRC ml/kg and anticonvulsants
34 Principles of care in Hemophilia Prevention of bleeding should be the goal, ideally by prophylaxis Acute bleeds should be treated early Home therapy should be used to manage only uncomplicated bleeding episodes Use a safe and effective FVIII concentrate with good supply line Regular exercise should be encouraged to promote strong muscles,protect joints and improve fitness WFH,Guidelines for the Management of Hemophilia 2005
35 When to introduce prophylaxis? The earlier, the better is the long-term outcome The earlier prophylaxis is started, the better the long-term outcome Primary prophylaxis may prevent recurrent bleeding and chronic arthropathy Secondary prophylaxis slows, but does not prevent, ongoing joint damage Astermark J, et al. Br J Haematol. 1999;105(4): Van den Berg HM, et al. Haemophilia. 2006;12(Suppl 3):
36 Case Study III A 2-year-old girl was referred for management of severe epistaxis. Having history of bleeding tendency in the family. No taking any medications.
37 Case Study III
38 Case study III CBC: Hb 9.9 g/dl MCV 68 fl, WBC 8,570/mm 3 (PMN 35 %, Band 1%, LL 26%, L 34%, Mo 4%), platelet count 274,000/mm 3 Bleeding time 15 min.(n 2-7) Coagulogram: aptt of 29 sec. (control 27.8) and PT 11.5 sec. (control 12) vwd work up: VWF: Ag 33 % (N=50-150%) VWF: Rco < 5 % (N=50-150%) VWF:CBA 22 % (N=50-150%) F VIII:C 50 % (N=50-150%)
39 Case study III vwf Multimers High moleular weight multimer Low moleular weight multimer Normal Patient Diagnosis: Von Willebrand disease type 2 A
40 Classification of VWD Type 1 (AD); represents 80% of cases Type 2 (AD,AR);15-20 % Type 2A (AD,AR) Type 2B (AD) Type 2M (AD,AR) Type 2N (AR) Type 3 (AR); severe type Partial quantitative deficiency of apparently normal vwf Qualitative deficiency of vwf Decreased VWF-dependent platelet adhesion with selective deficiency high molecular weight multimers (HMWM) Increased affinity for platelet glycoprotein Ib Decreased vwf-dependent platelet function without selective deficiency HMWM Markedly decreased binding affinity for factor VIII Virtually complete deficiency of vwf Sadler JE. J Thromb Haemost 2006; 4:
41 Treatment of VWD DDAVP (deamino-8- arginine vasopressin) plasma VWF levels by stimulating secretion from endothelium Maximal rise of vwf and FVIII is observed in minutes Typical maximal rise is 2- to 4-fold for vwf and 3- to 6-fold for FVIII Minirin Dosage 0.3 µg/kg in NSS 50 ml IV in 30 min q 12 hr Stimate Intranasal 150 µg in children less than 50 kg. 1,500 mcg/ml 100 mcg/ml Minirin
42 Treatment of VWD Cryoprecipitate Source of fibrinogen, factor VIII and VWF Only plasma fraction that consistently contains VWF multimers Factor VIII concentrate (Intermediate purity) Alphanate and Immunate Virally inactivated product Contain a near-normal complement of high molecular weight vwf multimers Antifibrinolytic drugs, preventing rapid clot dissolution Platelet transfusions May be helpful with vwd type 2B or refractory to other therapies
43 T H A A N K S
Bleeding Disorders. Dr. Mazen Fawzi Done by Saja M. Al-Neaumy Noor A Mohammad Noor A Joseph Joseph
Bleeding Disorders Dr. Mazen Fawzi Done by Saja M. Al-Neaumy Noor A Mohammad Noor A Joseph Joseph Normal hemostasis The normal hemostatic response involves interactions among: The blood vessel wall (endothelium)
More informationDr. MUBARAK ABDELRAHMAN MD PEDIATRICS AND CHILD HEALTH Assistant Professor FACULTY OF MEDICINE -JAZAN
Dr. MUBARAK ABDELRAHMAN MD PEDIATRICS AND CHILD HEALTH Assistant Professor FACULTY OF MEDICINE -JAZAN The student should be able:» To identify the mechanism of homeostasis and the role of vessels, platelets
More informationApproach to bleeding disorders &treatment. by RAJESH.N General medicine post graduate
Approach to bleeding disorders &treatment by RAJESH.N General medicine post graduate 2 Approach to a patient of bleeding diathesis 1. Clinical evaluation: History, Clinical features 2. Laboratory approach:
More informationCoagulation an Overview Dr.Abdolreza Abdolr Afrasiabi Thal assem a & Heamophili hilia G ene i tic R esearc C en er Shiraz Medical Medic University
In The Name God Coagulation an Overview Dr.Abdolreza Afrasiabi Thalassemia & Heamophilia Genetic Research hcenter Shiraz Medical University Bleeding Clotting Hemostasis Review of platelet function Platelets
More informationHemostasis. Learning objectives Dr. Mária Dux. Components: blood vessel wall thrombocytes (platelets) plasma proteins
Hemostasis Learning objectives 14-16 Dr. Mária Dux Components: blood vessel wall thrombocytes (platelets) plasma proteins Hemostatic balance! procoagulating activity anticoagulating activity 1 Thrombocytes
More informationCoagulation Disorders. Dr. Muhammad Shamim Assistant Professor, BMU
Coagulation Disorders Dr. Muhammad Shamim Assistant Professor, BMU 1 Introduction Local Vs. General Hematoma & Joint bleed Coagulation Skin/Mucosal Petechiae & Purpura PLT wound / surgical bleeding Immediate
More informationY. Helen Zhang, MD Andy Nguyen, MD 10/28/2012
Y. Helen Zhang, MD Andy Nguyen, MD 10/28/2012 Clinical History Patient: 23-year-old female Clinical course: status-post cholecystectomy, complicated by retained common bile duct stones. Following three
More informationBLEEDING (PLATELET) DISORDER. IAP UG Teaching slides
BLEEDING (PLATELET) DISORDER 1 APPROACH The initial set of questions should establish the following: (1) the most common site and type of bleeding (e.g., mucocutaneous versus articular or deep muscle),
More informationIntroduction to coagulation and laboratory tests
Introduction to coagulation and laboratory tests Marc Jacquemin Special Haemostasis Laboratory Center for Molecular and Vascular Biology University of Leuven Coagulation in a blood vessel: fibrin stabilises
More informationBleeding Disorders HOPE Maram Al-anbar
Bleeding Disorders HOPE Maram Al-anbar 9-9 - 2014 ^^ Attention Please ^^ We ( correction team of pediatric package^hope/2010^ ) had decided to make one lecture of bleeding disorders in place of the two
More informationEasy bruising vs Coagulopathy
Easy bruising vs Coagulopathy Sept. 19, 2015 Lakehead Summer School Chris Hillis, MD MSc FRCPC hillis@hhsc.ca @HemeHillis Aim & Objectives Aim: To increase comfort in detecting non-pathologic bleeding
More informationL iter diagnostico di laboratorio nelle coagulopatie congenite emorragiche
L iter diagnostico di laboratorio nelle coagulopatie congenite emorragiche Armando Tripodi Angelo Bianchi Bonomi Hemophilia and Thrombosis Center Dept. of Clinical Sciences and Community Health University
More informationPrimary Exam Physiology lecture 5. Haemostasis
Primary Exam Physiology lecture 5 Haemostasis Haemostasis Body s response for the prevention and cessation of bleeding. Broadly consists of: Primary Haemostasis - vascular spasm and platlet plug formation
More informationDr. Rai Muhammad Asghar Associate Professor Head of Pediatric Department Rawalpindi Medical College
Dr. Rai Muhammad Asghar Associate Professor Head of Pediatric Department Rawalpindi Medical College AN APPROACH TO BLEEDING DISORDERS NORMAL HEMOSTASIS After injury, 3 processes halt bleeding Vasoconstriction
More informationApproach To A Bleeding Patient
ABDUL MAJEED, RAHUL RAJEEV REVIEW ARTICLE INTRODUCTION Hemostasis is the process of forming clots in the walls of damaged blood vessels and preventing blood loss while maintaining blood in a fluid state
More informationHaemostasis & Coagulation disorders Objectives:
Haematology Lec. 1 د.ميسم مؤيد علوش Haemostasis & Coagulation disorders Objectives: - Define haemostasis and what are the major components involved in haemostasis? - How to assess the coagulation status?
More informationBleeding disorders. Hemostatic failure: Inappropriate and excessive bleeding either spontaneous or in response to injury.
1 Bleeding disorders Objectives: 1. Discuss briefly the physiology of hemostasis. 2. Define the mechanisms of thrombocytopenia and the relative bleeding risk at any given platelet count. 3. Be able to
More informationEDUCATIONAL COMMENTARY PLATELET DISORDERS
EDUCATIONAL COMMENTARY PLATELET DISORDERS Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE credits click on Earn
More informationThis slide belongs to iron lecture and it is to clarify the iron cycle in the body and the effect of hypoxia on erythropoitein secretion
This slide belongs to iron lecture and it is to clarify the iron cycle in the body and the effect of hypoxia on erythropoitein secretion Topics of today lectures: Hemostasis Meaning of hemostasis Mechanisms
More informationCongenital bleeding disorders
Congenital bleeding disorders Overview Factor VIII von Willebrand Factor Complex factor VIII von Willebrand factor (vwf) complex circulate as a complex + factor IX intrinsic pathway Platelets bind via
More informationBlood coagulation and fibrinolysis. Blood clotting (HAP unit 5 th )
Blood coagulation and fibrinolysis Blood clotting (HAP unit 5 th ) Vessel injury Antithrombogenic (Favors fluid blood) Thrombogenic (Favors clotting) 3 Major systems involved Vessel wall Endothelium ECM
More informationHEMOSTASIS/THROMBOSIS II
HEMOSTASIS/THROMBOSIS II Congenital/Acquired Hemorrhagic Disorders & Their Treatment COAGULATION TESTING!Bleeding time primary screening test for platelet function!if bleeding time abnormal!platelet Aggregation
More informationBLEEDING DISORDERS Simple complement:
BLEEDING DISORDERS Simple complement: 1. Select the statement that describe the thrombocytopenia definition: A. Marked decrease of the Von Willebrandt factor B. Absence of antihemophilic factor A C. Disorder
More informationSysmex Educational Enhancement and Development No
SEED Coagulation Sysmex Educational Enhancement and Development No 2 2016 An approach to the bleeding patient The purpose of this newsletter is to provide an overview of the approach to the bleeding patient
More informationCh. 45 Blood Plasma proteins, Coagulation and Fibrinolysis Student Learning Outcomes: Describe basic components of plasma
Chapt. 45 Ch. 45 Blood Plasma proteins, Coagulation and Fibrinolysis Student Learning Outcomes: Describe basic components of plasma Inheritance of X-linked gene for Factor VIII hemophilia A Explain the
More informationUNIT VI. Chapter 37: Platelets Hemostasis and Blood Coagulation Presented by Dr. Diksha Yadav. Copyright 2011 by Saunders, an imprint of Elsevier Inc.
UNIT VI Chapter 37: Platelets Hemostasis and Blood Coagulation Presented by Dr. Diksha Yadav Hemostasis: Prevention of Blood Loss Vascular constriction Formation of a platelet plug Formation of a blood
More informationBleeding and Haemostasis. Saman W.Boskani HDD, FIBMS Maxillofacial Surgeon
Bleeding and Haemostasis Saman W.Boskani HDD, FIBMS Maxillofacial Surgeon 1 Beeding Its escaping or extravasation of blood contents from blood vessels Types: - Arterial - Venous - Capillary Differences
More informationEasy Bleeding General Presentation
Easy Bleeding General Presentation It is not uncommon for children to bleed and bruise after experiencing trauma. However, a child may also have an underlying coagulopathy, which results in easy and possibly
More information-Hashim ahmed is the one who wrote this sheet. I just edited it according to our record.
* Subjects of this lecture : - Hemostasis - Platelets, general information, their ultrastructure and role in hemostasis. - Definitions: Thrombus, Embolus, Arteriosclerosis and Atherosclerosis. *NOTE: Prof
More informationTREATMENT & MANAGEMENT OF VON WILLEBRAND DISEASE
TREATMENT & MANAGEMENT OF VON WILLEBRAND DISEASE Dr Susan Russell Director HTC Sydney Children s Hospital, Randwick HFA Meeting 2015 What is von Willebrand Factor? VWF is a large multimeric protein Two
More informationHemostatic derangement in Dengue infection
Hemostatic derangement in Dengue infection By Assoc. Prof. Darintr Sosothikul, MD Pediatric Hematology-Oncology division, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University
More informationHAEMORRHAGIA Bleeding
HAEMORRHAGIA Bleeding Cassification Size Location pathomechanism Hematoma: external or may be enclosed within a tissue petechiae : 1-2 mm hemorrhages into skin, mucous membranes, or serosal surfaces increased
More informationTest Name Results Units Bio. Ref. Interval
LL - LL-ROHINI (NATIONAL REFERENCE 135091668 Age 40 Years Gender Male 29/8/2017 120000AM 29/8/2017 100156AM 29/8/2017 120820M Ref By Final COAGULATION ROFILE 2 FACTOR VIII FUNCTIONAL /ACTIVITY (Electromechanical
More informationGeneral approach to the investigation of haemostasis. Jan Gert Nel Dept. of Haematology University of Pretoria 2013
General approach to the investigation of haemostasis Jan Gert Nel Dept. of Haematology University of Pretoria 2013 Clinical reasons to investigate haemostasis Investigating a clinically suspected bleeding
More informationPart IV Antithrombotics, Anticoagulants and Fibrinolytics
Part IV Antithrombotics, Anticoagulants and Fibrinolytics "The meaning of good and bad, of better and worse, is simply helping or hurting" Emerson Chapter 16: Blood Coagulation and Fibrinolytic System
More informationBleeding and Thrombotic Disorders. Kristine Krafts, M.D.
Bleeding and Thrombotic Disorders Kristine Krafts, M.D. Bleeding and Thrombotic Disorders Bleeding disorders von Willebrand disease Hemophilia A and B DIC TTP/HUS ITP Thrombotic disorders Factor V Leiden
More informationThe LaboratoryMatters
Laboratory Medicine Newsletter for clinicians, pathologists & clinical laboratory technologists. A Initiative. HEMOSTASIS AND THE LABORATORY This issue highlights: Primary Hemostasis Screening Tests Case
More informationHemostasis and Thrombosis
Hemostasis Hemostasis and Thrombosis Normal hemostasis is a consequence of tightly regulated processes that maintain blood in a fluid state in normal vessels, yet also permit the rapid formation of a hemostatic
More informationHEME 10 Bleeding Disorders
HEME 10 Bleeding Disorders When injury occurs, three mechanisms occur Blood vessels Primary hemostasis Secondary hemostasis Diseases of the blood vessels Platelet disorders Thrombocytopenia Functional
More informationTopics of today lectures: Hemostasis
Topics of today lectures: Hemostasis Meaning of hemostasis Mechanisms of hemostasis - Vascular contraction - Platelets plug - Blood coagulation (clotting) - Structure and functions of platelets - Blood
More informationRoutine preoperative coagulation tests: are they necessary?
Routine preoperative coagulation tests: are they necessary? Dr Azzah Alzahrani MD Pediatrics Hematology /Oncology PSMMS Outline Introduction. Brief review of hemostatic mechanisms. A clinical aspect of
More informationProthrombin Complex Concentrate- Octaplex. Octaplex
Prothrombin Complex Concentrate- Concentrated Factors Prothrombin Complex Concentrate (PCC) 3- factor (factor II, IX, X) 4-factor (factors II, VII, IX, X) Activated 4-factor (factors II, VIIa, IX, X) Coagulation
More informationEffective Date: Approved by: Laboratory Director, Jerry Barker (electronic signature)
1 of 5 Policy #: 702 (PHL-702-05) Effective Date: 9/30/2004 Reviewed Date: 8/1/2016 Subject: TRANSFUSION GUIDELINES Approved by: Laboratory Director, Jerry Barker (electronic signature) Approved by: Laboratory
More informationACQUIRED COAGULATION ABNORMALITIES
ACQUIRED COAGULATION ABNORMALITIES ACQUIRED COAGULATION ABNORMALITIES - causes 1. Liver disease 2. Vitamin K deficiency 3. Increased consumption of the clotting factors (disseminated intravascular coagulation
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our
More informationBleeding Problems in Asian Population. Ponlapat Rojnuckarin Chulalongkorn University
Bleeding Problems in Asian Population Ponlapat Rojnuckarin Chulalongkorn University ARE ASIANS MORE LIKELY TO BLEED? Hemorrhagic stroke is more common in Asia Countries/Areas Ischemic: Hemorrhagic Stroke
More informationINHERITED COAGULOPATHY
Disorder Etiology Pathophysiology and Presentation Lab Findings and Diagnosis Treatment INHERITED COAGULOPATHY HEMOPHILIA A and B Hemophilia A: deficiency in XIII (85%) Hemophilia B: deficiency in IX (15%)
More informationChapter 19. Hemostasis
Chapter 19 Hemostasis Hemostasis Hemostasis is the cessation of bleeding stopping potentially fatal leaks important in small blood vessels not effective in hemorrhage excessive bleeding from large blood
More informationBleeding Disorders.1 MS4.24.Feb.19. Abdallah Awidi Abbadi.MD. FRCP.FRCPath Professor
Bleeding Disorders.1 MS4.24.Feb.19 Abdallah Awidi Abbadi.MD. FRCP.FRCPath Professor Email: abdalla.awidi@gmail.com Hemostasis BV Injury Neural Contact Damage/contact. Blood Vessel Constriction Reduced
More informationHemostasis. PHYSIOLOGICAL BLOOD CLOTTING IN RESPONSE TO INJURY OR LEAK no disclosures
Hemostasis PHYSIOLOGICAL BLOOD CLOTTING IN RESPONSE TO INJURY OR LEAK no disclosures Disorders of Hemostasis - Hemophilia - von Willebrand Disease HEMOPHILIA A defect in the thrombin propagation phase
More informationCigna Drug and Biologic Coverage Policy
Cigna Drug and Biologic Coverage Policy Subject Clotting Factors and Antithrombin Effective Date... 4/15/2018 Next Review Date... 3/15/2019 Coverage Policy Number... 8007 Table of Contents Coverage Policy...
More informationCoagulopathy Case - 3. Andy Nguyen, M.D. 2009
Coagulopathy Case - 3 Andy Nguyen, M.D. 2009 CLINICAL HISTORY A 21 year-old male seen in the emergency room with a swollen, tender right knee. Patient is an electrician who had fallen to the ground an
More informationGLANZMANN S THROMBASTHENIA. Stacey Shiovitz January 13, 2012
GLANZMANN S THROMBASTHENIA Stacey Shiovitz January 13, 2012 HELP!! MY PATIENTHASGT DO YOU EVEN KNOW WHAT THAT IS? CASE 27yo woman presented tdto gynecology clinic i for menorrhagia x 10 days Bleeding started
More informationChapter 3. Haemostatic abnormalities in patients with liver disease
Chapter 3 Haemostatic abnormalities in patients with liver disease Ton Lisman, Frank W.G. Leebeek 1, and Philip G. de Groot Thrombosis and Haemostasis Laboratory, Department of Haematology, University
More informationEvaluating for Suspected Child Abuse: Conditions That Predispose to Bleeding
FROM THE AMERICAN ACADEMY OF PEDIATRICS TECHNICAL REPORT Evaluating for Suspected Child Abuse: Conditions That Predispose to Bleeding Shannon L. Carpenter, MD, MS, Thomas C. Abshire, MD, James D. Anderst,
More informationPlatelet Disorders. By : Saja Al-Oran
Platelet Disorders By : Saja Al-Oran Introduction The platelet arise from the fragmentation of the cytoplasm of megakaryocyte in the bone marrow. circulate in the blood as disc-shaped anucleate particles
More informationLifeBridge Health Transfusion Service Sinai Hospital of Baltimore Northwest Hospital Center BQA Transfusion Criteria Version#2 POLICY NO.
LifeBridge Health Transfusion Service Sinai Hospital of Baltimore Northwest Hospital Center BQA 1011.02 Transfusion Criteria Version#2 Department POLICY NO. PAGE NO. Blood Bank Quality Assurance Manual
More informationM B Garvey. University of Toronto
Do I really need that test??? M B Garvey Professor Emeritus University of Toronto St Michael s Hospital No relevant conflicts of interest 1 HEMOSTASIS IS LIKE LOVE Everybody talks about it, nobody understands
More informationHAEMORRHAGIA Bleeding
HAEMORRHAGIA Bleeding Cassification Size Location pathomechanism Hematoma: external or may be enclosed within a tissue petechial rash (spot) : 1-2 mm hemorrhages into skin, mucous membranes, or serosal
More informationDiagnosis of hypercoagulability is by. Molecular markers
Agenda limitations of clinical laboratories to evaluate hypercoagulability and the underlying cause for thrombosis what is the INR the lupus anticoagulant and the antiphospholipid antibody syndrome hassouna
More informationDisseminated Intravascular Coagulation. M.Bahmanpour MD Assistant professor IUMS
به نام خدا Disseminated Intravascular Coagulation M.Bahmanpour MD Assistant professor IUMS Algorithm for Diagnosis of DIC DIC Score factor score Presence of known underlying disorder No= 0 yes=2 Coagolation
More informationvon Willebrand Disease
von Willebrand Disease Jeremy Robertson Paediatric Haematologist Royal Children s s Hospital & Pathology Queensland Foglo,, April 1924: the journey begins Oskar and Augusta sail to Helsinki... ...to o
More informationPediatric Coagulation Disorders
Pediatric Coagulation Disorders Vilmarie Rodriguez, MD,* Deepti Warad, MBBS* *Division of Pediatric Hematology-Oncology, Mayo Clinic Children s Center, Mayo Clinic Comprehensive Hemophilia Center, Mayo
More informationEDUCATIONAL QUIZ WITH VOTING ON VWD TOPIC. P. Smejkal Department of Hematology, Masaryk University Hospital Brno, Czech Republic
EDUCATIONAL QUIZ WITH VOTING ON VWD TOPIC P. Smejkal Department of Hematology, Masaryk University Hospital Brno, Czech Republic Classification of von Willebrand disease type 1 partial quantitative deficiency,
More informationBlood clotting. Subsequent covalent cross-linking of fibrin by a transglutaminase (factor XIII) further stabilizes the thrombus.
Blood clotting It is the conversion, catalyzed by thrombin, of the soluble plasma protein fibrinogen (factor I) into polymeric fibrin, which is deposited as a fibrous network in the primary thrombus. Thrombin
More informationLocal vasoconstriction. is due to local spasm of the smooth muscle (symp. reflex) can be maintained by platelet vasoconstrictors
Hemostasis Hemostasis ( hemo =blood; sta= remain ) is the stoppage of bleeding, which is vitally important when blood vessels are damaged. Following an injury to blood vessels several actions may help
More informationBleeding Disorders: (Hemorrhagic Diatheses) Tests used to evaluate different aspects of hemostasis are the following:
Bleeding Disorders: (Hemorrhagic Diatheses) Excessive bleeding can result from: 1. Increased fragility of vessels. 2. Platelet deficiency or dysfunction. 3. Derangement of coagulation. 4. Combinations
More informationGUIDELINES. for the diagnosis and management of von Willebrand disease (VWD)
GUIDELINES for the diagnosis and management of von Willebrand disease (VWD) The Canadian Hemophilia Society (CHS) is committed to improve the health and quality of life of all people with inherited bleeding
More informationHemophilia: diagnostics and treatment
Hemophilia: diagnostics and treatment Eveline Mauser-Bunschoten Van Creveldkliniek department of benign hematology thrombosis and hemostasis What is hemophilia? Hemophilia A: deficiency of factor VIII
More informationHaemorrhagic Disorders. Dr. Bashar Department of Pathology Mosul Medical College
Haemorrhagic Disorders Dr. Bashar Department of Pathology Mosul Medical College Hemorrhagic Disorders These include Disorders of platelets. Disorders of blood vessels. Disorders of coagulation & fibrinolysis.
More informationPlatelet vs. Coagulation Bleeding. Qualitative and Quantitative Platelet Disorders. Laboratory Tests. Platelet Signaling. Jeffrey S. Jhang, M.D.
Qualitative and Quantitative Platelet isorders Platelet vs. Coagulation Bleeding Findings Petechiae Hematomas and Hemarthroses elayed Bleeding Coagulation Rare Common Common Platelet Common Rare Rare Bleeding
More informationCommonly Encountered Hematologic Chief Complaints in the Pediatric Pa8ent Black Hills Pediatric Symposium 6/23/17 Sam Milanovich, MD Pediatric
Commonly Encountered Hematologic Chief Complaints in the Pediatric Pa8ent Black Hills Pediatric Symposium 6/23/17 Sam Milanovich, MD Pediatric Hematology/Oncology Sanford Children s Specialty Clinic Sioux
More informationImportant Considera/ons for Coagula/on Tests on Children and Neonates
Important Considera/ons for Coagula/on Tests on Children and Neonates Cindy Neunert, MD MSCS Associate Professor Pediatric Hematology/Oncology/Bone Marrow Transplant Columbia University Medical Center
More informationWHITE PAPERS PRESENTATION VIDEO DOCUMENTATION EXPERIMENT WO NDCLOT. The WoundClot Principals for Effective Bleeding Control PRESENTATION
WHITE PAPERS PRESENTATION VIDEO DOCUMENTATION EXPERIMENT ARTICLES OUR STUDY BLEEDING CONTROL 5 POINT MODEL WO NDCLOT The WoundClot Principals for Effective Bleeding Control PRESENTATION Harnessing SCIENCE
More informationPhysiology of. The Blood hemostasis. By prof. Israa f. jaafar
Physiology of The Blood hemostasis By prof. Israa f. jaafar Learning objectives Understand the Platelet structure and function Explane the Platelet production Understand the phases of hemostasis: vascular
More informationA s doctors who care for children, we have a
1163 PERSONAL PRACTICE The bleeding child; is it NAI? A E Thomas... As a paediatric haematologist, the question of whether a child has been abused or whether they might have a bleeding diathesis is a question
More informationTest Name Results Units Bio. Ref. Interval
LL - LL-ROHINI (NATIONAL REFERENCE 135091667 Age 37 Years Gender Male 29/8/2017 120000AM 29/8/2017 100129AM 29/8/2017 113851AM Ref By Final COAGULATION ROFILE 1 ARTIAL THROMBOLASTIN TIME, ACTIVATED; ATT
More informationPOLICY NO. Printed copies are for reference only. Please refer to the electronic copy for the latest version.
Department Blood Bank POLICY NO. 4633 Department Of Pathology LBH Transfusion Criteria Version# 2 PAGE NO. 1 OF 9 Printed copies are for reference only. Please refer to the electronic copy for the latest
More informationReview Article Sri Lanka Dental Journal 2016; 46(01) 05-13
Review Article Sri Lanka Dental Journal 2016; 46(01) 05-13 The Importance of Knowing the Patient s Clotting Profile before Dental Treatment N.A. Alles, N.S. Soysa Introduction Patients having bleeding
More informationBalanced Transfusion Resuscitation
Transparency in Transfusion Medicine 2013 Balanced Transfusion Resuscitation HGD Hendriks MD, PhD University Medical Center Groningen Balancing 1 2 3 Preoperative Peroperative Postoperative Balanced Coagulation
More informationBlood Transfusion Guidelines in Clinical Practice
Blood Transfusion Guidelines in Clinical Practice Salwa Hindawi Director of Blood Transfusion Services Associate Professor in Haematology and Transfusion Medicine King Abdalaziz University, Jeddah Saudi
More informationBLEEDING DISORDERS. JC Opperman 2012
BLEEDING DISORDERS JC Opperman 2012 Primary and Secondary Clotting Laboratory Tests Routine screening tests Prothrombin time (PT) (INR) increased in neonates (12-18 sec) Partial thromboplastin time (PTT)
More informationThursday, February 26, :00 am. Regulation of Coagulation/Disseminated Intravascular Coagulation HEMOSTASIS/THROMBOSIS III
REGULATION OF COAGULATION Introduction HEMOSTASIS/THROMBOSIS III Regulation of Coagulation/Disseminated Coagulation necessary for maintenance of vascular integrity Enough fibrinogen to clot all vessels
More informationIntroduction to von Willebrand Disease Mary Lesh RN, MS, CPNP
Introduction to von Willebrand Disease Mary Lesh RN, MS, CPNP OVERVIEW Von Willebrand Disease (VWD) is the most common hereditary bleeding disorder in humans, with an estimated prevalence ranging upward
More informationHemostasis and thrombosis in patients with liver disease. Ton Lisman, Dept Surgery, UMC Groningen, The Netherlands
Hemostasis and thrombosis in patients with liver disease Ton Lisman, Dept Surgery, UMC Groningen, The Netherlands Importance of the liver in hemostasis Synthesis of Coagulation factors Fibrinolytic proteins
More informationHemostasis Haemostasis means prevention of blood loss from blood vessels.
١ Hemostasis Haemostasis means prevention of blood loss from blood vessels. Bleeding is stopped by several mechanisms, which are: 1. Local vasoconstriction 2. Formation of platelet plug 3. Blood coagulation
More informationDISSEMINATED INTRAVASCULAR COAGULATION (DIC) Pichika Chantrathammachart MD Division of Hematology, Department of Medicine Ramathibodi Hospital
DISSEMINATED INTRAVASCULAR COAGULATION (DIC) Pichika Chantrathammachart MD Division of Hematology, Department of Medicine Ramathibodi Hospital Disseminated intravascular coagulation (DIC) Disseminated
More informationChapter 19 Blood Lecture Outline
Chapter 19 Blood Lecture Outline Cardiovascular system Circulatory system Blood 1. distribution 2. regulation 3. protection Characteristics: ph 7.4 38 C 4-6 L Composition: Plasma Formed elements Erythrocytes
More informationHemostasis and. Blood Coagulation
Hemostasis and Blood Coagulation Events in Hemostasis The term hemostasis means prevention of blood loss. Whenever a vessel is severed or ruptured, hemostasis is achieved by several mechanisms: (1) vascular
More informationChapter 1 Introduction
Chapter 1 Introduction There are several disorders which carry an increased risk of thrombosis, clots that interfere with normal circulation, including: venous thromboembolism (VTE), comprising both deep
More informationHemostatic System - general information
PLATELET DISORDERS Hemostatic System - general information Normal hemostatic system vessel wall circulating blood platelets blood coagulation and fibrynolysis Bleeding Diathesis inherited or acquired defects
More information3/19/2012. What is the indication for anticoagulation? Has the patient previously been on warfarin? If so, what % of the time was the INR therapeutic?
Abigail E. Miller, PharmD, BCPS Clinical Specialist, Cardiology University of North Carolina Hospitals I have no personal financial relationships with the manufacturers of the products to disclose. Boehringer
More informationAnatomy and Physiology
Anatomy and Physiology For The First Class 2 nd Semester Thrombocytes = Platelets Thrombocytes = Platelets Blood platelets are non-nucleated disc like cell fragments 2-4 µm in diameter. Platelets are not
More informationKoostas: Anneli Aus Laboriarst Allkiri Ees- ja perekonnanimi Ametikoht kuupäev
Kinnitas: Elektroonselt Katrin Reimand Osakonnajuhataja 05.07.2017 kinnitatud Koostas: Anneli Aus Laboriarst 05.07.2017 Allkiri Ees- ja perekonnanimi Ametikoht kuupäev Haematology reference values Analyte
More informationHemostasis. Clo)ng factors and Coagula4on NORMAL COAGULATION. Overview of blood coagula4on. The Cascade Theory 5/1/12. Clot
Hemostasis Clo)ng factors and Coagula4on Dr Badri Paudel www.badripaudel.com Hemostasis is defined as a property of circula4on whereby blood is maintained within a vessel and the ability of the system
More informationThe Clinical Features of Chinese Children with von Willebrand Disease: The Experience of a Tertiary Institute
HK J Paediatr (new series) 2011;16:95-100 The Clinical Features of Chinese Children with von Willebrand Disease: The Experience of a Tertiary Institute ZQ ZHANG, GCF CHAN, CCK LAM, JCC SO, DKL CHEUK, AKS
More informationDiagnosis and Management of Von Willebrand Disease
CLINICAL VIGNETTE Diagnosis and Management of Von Willebrand Disease Olga Olevsky, M.D. and Stephen Wong, M.D. Von Willebrand s Disease is the most common inherited bleeding disorder. Low levels of Von
More informationMANAGEMENT OF COAGULOPATHY AFTER TRAUMA OR MAJOR SURGERY
MANAGEMENT OF COAGULOPATHY AFTER TRAUMA OR MAJOR SURGERY 19th ANNUAL CONTROVERSIES AND PROBLEMS IN SURGERY Thabo Mothabeng General Surgery: 1 Military Hospital HH Stone et al. Ann Surg. May 1983; 197(5):
More informationTRANSFUSIONS FIRST, DO NO HARM
TRANSFUSIONS FIRST, DO NO HARM BECAUSE BLOOD CAN KILL 7 TRALI DEATHS SINCE 2002 WMC 5 women BECAUSE In OB you are transfusing 2 instead of 1 BECAUSE BLOOD IS A LIQUID TRANSPLANT RISKS versus BENEFITS versus
More information>>FAST TRACK<< Hemostasis has three key components: platelets, the plasma coagulation. cascade, and the blood vessel wall (endothelium).
How to Reverse an Antithrombotic Agent The authors review options and precautions to consider when you need to restore hemostasis in a patient receiving an anticoagulant, antiplatelet, or fibrinolytic
More information