Identification and Basic Management of Bleeding Disorders in Adults

Abstract

Adults with bleeding disorders may present to their family physician with minor bleeding symptoms or hematologic laboratory abnormalities discovered during evaluation for surgery or another purpose. Identifying the small proportion of adults who have an underlying bleeding disorder as the cause for such signs or symptoms may be challenging. In cases of asymptomatic hematologic laboratory abnormalities, the particular abnormality should narrow down the potentially affected hemostatic component(s), ideally streamlining subsequent investigation. In patients presenting with bleeding symptoms, a thorough history and physical examination are critical for first identifying bleeding as pathologic, then performing the appropriate diagnostic evaluation after excluding identifiable causes. Knowledge of the pathophysiologic processes contributing to impaired hemostasis in any given bleeding disorder ensures proper treatment and avoids therapies that are unnecessary or even contraindicated. Management is further determined by bleeding phenotype and, for invasive procedures, the anticipated risk for bleeding. Consultation with a hematologist may facilitate proper evaluation and treatment, particularly in adults with rare bleeding disorders or no identifiable cause for bleeding. This article reviews the diagnostic approach to hematologic laboratory abnormalities and abnormal bleeding in adults, as well as basic preventive care and hemostatic management of adults with bleeding disorders. (J Am Board Fam Med 2014;27:549 -564.)

Measurement of Platelet Function in an Experimental Stroke Model With Aspirin and Clopidogrel Treatment

“…As a result LTA is too invasive to be used as a measure of platelet status at the time of experimental stroke surgery. A simple-to-conduct but unspecific method is the tail bleeding test, which illustrates platelet adhesion in vivo and corresponds to the bleeding time test formerly used in patients (15,16). The principle underlying this test is that platelet function directly affects primary hemostasis after tissue damage, resulting in prolonged bleeding time (time to complete cessation of the bleeding) and increased blood volumes during testing in mice.…”

Preanalytic processing of rat plasma influences thrombin generation and fibrinolysis assays

“…The APTT and PT assays are traditional coagulation screening tests widely used in diagnostic laboratories . The assays are configured with specific trigger reagents that differentially activate the coagulation cascade via the intrinsic or extrinsic pathway .…”

“…7,8 The APTT and PT assays are traditional coagulation screening tests widely used in diagnostic laboratories. 9,10 The assays are configured with specific trigger reagents that differentially activate the coagulation cascade via the intrinsic or extrinsic pathway. 11 In these assays, prolongation of clot formation time indicates deficiency, dysfunction, or inhibition of one or more coagulation factors.…”

Hemostasis and Thrombosis in the Oldest Old

“…Genetic thrombophilia, major surgery, and immobility add to this hypercoagulable tendency. 16,51 At the same time, diseases such as liver disorders, renal failure, myeloproliferative neoplasms (MPN), autoimmune conditions, malignancies, and bone marrow suppression due to diseases or treatment (chemotherapy, radiation), which are otherwise prevalent among the elderly, contribute to the bleeding risk. Bleeding is a common phenomenon among elderly males and females.…”