Unexpected Bleeding Disorders

Abstract

Patients with known coagulation deficiencies, either congenital or acquired, may bleed spontaneously with trauma or with surgical intervention. In contrast, however, are the unchallenged patients who bleed in a variety of clinical settings that demand rapid diagnosis so that appropriate therapy can be instituted.In the first section Dr. Louis M. Aledort demonstrates a series of vignettes of actual cases who presented with unexpected bleeding or a screening laboratory abnormality prior to a needed surgical intervention. Settings include dental, oral surgical, obstetrical, surgical and gynecological. The differential diagnoses of these cases are discussed.In the second section Dr. David Green also uses vignettes to demonstrate how the laboratory is used to differentiate the various clinical entities. The choice and priority of required tests indicated by the settings, history, site and type of bleeding, and the syllogisms used to define the abnormality are stressed.In the third section, Dr. Jerome Teitel reviews in detail the therapeutic armamentarium available to the clinician and presents algorithms for the management of these bleeding disorders.

Hemodynamic Instability after Low-Energy Thigh Contusion Caused by Injury to the Femoral Artery: A Case Report and Literature Review

“…In such cases, clinicians should look out for structural alterations in the vessels that predispose them to injury or impaired blood clotting. In patients with a history of collagen alterations (e.g., Ehlers-Danlos syndrome), weakness in the tissue of the large arteries, intestine, and uterus leads to a high predisposition to arterial rupture in any location either spontaneously or after mild trauma [ 5 – 9 ]. Ehlers-Danlos syndrome is a rare heterogeneous group of connective tissue disorders caused by a defect in the synthesis of collagen, with estimated population prevalence between 1/5000 and 1/25000 [ 11 ].…”

“…Acute vascular injuries have been described in relation to high-energy accidents in patients who are polytraumatised or undergoing surgery in the femoral area [ 1 – 4 ], but this diagnosis is very rare in young patients with no relevant medical history. In such cases, clinicians should be alert to the possibility of structural alterations in the vessels that predispose them to injury or impaired blood clotting [ 5 – 9 ]. We present the case of a patient who sustained a direct, low-energy contusion in the thigh and presented a femoral injury.…”

Transient Acquired Hemophilia Associated with Mycoplasma Pneumoniae Pneumonia

“…Thus, mixing studies provide a critical tool to distinguish between the presence of a coagulation factor deficiency and a circulating anti-FVIII. Antibodies to FVIII may be quantified by the Bethesda assay that allows quantitation of the inhibitor strength (11). In our patient, we confirmed the diagnosis of AH by the presence of multiple ecchymotic lesions, a prolonged aPTT, normal PT, low FVIII activity, and the presence of FVIII inhibitor.…”

Hereditary Coagulation Factor Deficiencies: Single Center Experience

“…Hemofi lilerin genel olarak ilk başvuru semptomları ciltte kolay morarma, ağız içine kanama, eklem kanamaları ve kas içine olan kanamalardır (7). Ağır hemofi lide spontan kanama sıklıkla görülürken, orta ve hafi f hemofi lide genellikle travma veya cerrahi sonrası kanama görülmektedir (14). (17)(18)(19).…”