Bleeding disorders and risk
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Incomplete information; this section will be expanded, clarified, and with references added in the future.
Initial evaluation
- Bleeding history (acquired or inherited disorder?)
- Spontaneous or provoked by surgery, tooth extraction, etc.
- Tolerance of prior surgery
- Menses
- Mucocutaneous bleeding, petechiae, oozing at line sites
- Bruising, hemarthrosis
- Family history--known hemophilia A, hemophilia B, von Willebrand disease (VWD), platelet function disorder
- Need for transfusion or product
- History of trauma, surgery
- PT/INR
- PTT
- Platelet count
- +/- fibrinogen (DIC), D-dimer, fibrin/fibrinogen degradation products (FDP)
- Kidney disease (uremia)
- Medications: anticoagulants, antiplatelet medications such as aspirin and Clopidogrel (Plavix), NSAIDS, antidepressants which cause decrease in platelet function
Abnormal PT/INR or PTT
- 1:1 mixing study (50/50 mixing study, circulating anticoagulant)
- Liver disease
- Elevated PT only
- Vitamin K deficiency
- Warfarin
- Dietary habits
- Antibiotic use
- Malnutrition
- Increased gut motility
- Deficiency or inhibitor of factor VII
- Lupus anticoagulant (rarely)
- Vitamin K deficiency
- Elevated PTT only
- Heparin
- Deficiencies of factor VIII, factor IX, factor XI, factor XII, or inhibitors
- von Willebrand disease
- Lupus anticoagulant
- Elevated PT & PTT
- Deficiences of prothrombin (factor II), factor V, factor X, fibrinogen
- DIC