Bleeding disorders and risk

Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.

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)
• 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