Acquired Bleeding Disordres

Question 1

What are the major Acquired bleeding disorders?

Answer 1

1) Thrombocytopenia
2) Liver Failure
3) Drugs
4) Haemorrhagic Disease of Newborn

Question 2

How would you spot someone who’s thrombocytopenic?

Answer 2

Petechia
Ecchymosis
Mucosal bleeding
Rarely a CNS bleed

Then FBC

Question 3

What are the major causes of thrombocytopenia?

Answer 3

Marrow failure or infiltration

ITP, DIC or hypersplenism

Question 4

What could trigger Idiopathic Thrombocytopenic Purpura?

Answer 4

EBV
HIV
Lymphoma
Collagenosis
Quinine use

Question 5

How do you diagnose ITP?

Answer 5

Patient presents with clinical history of thrombocytopenia i.e. bruising, petechia & mucosal bleeds

+ FBC showing thrombocytopenia

Very rarely need marrow tests

Question 6

How do we treat ITP acutely?

Answer 6

Steroids & IV IgG

Question 7

How do we manage ITP chronically?

Answer 7

Most cases are just one episode but if its long term:

• Platelet count good between episodes? Then leave it
• Platelet count consistently low? –> Thombopoietin Analogues

Question 8

How does liver disease contribute to bleeding?

Answer 8

Liver produces a lot of coagulation factors + Fibrinogen + Thrombopoietin
So someone with chronic liver disease will produce less –> Excess of both bleeding

Question 9

Where do people with liver disease tend to bleed from?

Answer 9

Varices

Question 10

Drugs cause most cases of acquired bleeding disorder, what ones particularly?

Answer 10

Warfarin
Heparins
Aspirin
Anti-platelets
DOACs

Question 11

What is haemorrhagic disease of a newborn?

Answer 11

Babies with immature coagulation system + Vit K deficiency —> Fatal Haemorrhage

Very rare in the western world as we give newborns a Vit K inj