Coagulation:- part 2 – Coagulation Screening, Work up of Bleeding Disorder

Definition of bleeding disorders:

1. Before we start work up of bleeding disorder, we should understand two systems of bleeding.
2. Bleeding disorders may be of two types:
   1. Primary hemostasis, related to:
      1. Platelets.
      2. Vascular defects.
   2. Secondary hemostasis related to:
      1. Coagulation factors defects.

Table to differentiate two types:

Clinical feature	Primary Hemostasis	Secondary Hemostasis
Onset time	Immediately after trauma	Occurs Late after trauma
Clinical presentation	Petechiae Ecchymosis	Hematoma
Sites	Mucous membrane skin	Deep Tissue Joints and muscles CNS
Mucous membranes	Nasal Oral GI Urinary	Less common
Examples	Thrombocytopenia Willebrand disease Platelets defects	Factors deficiency Liver diseases Acquired inhibitors

Bleeding disorder test profile consists of:

1. Platelets.
2. Bleeding time.
3. Clotting time.
4. APTT.
5. PTT.
6. PT.
7. Clotting factor assay.

Platelets abnormality is seen in :

1. Idiopathic thrombocytopenia.
2. Low due to drugs.
3. Hypersplenism.
4. SLE.
   • (See more in Platelets)

Abnormal PTT alone is seen in:

• Bleeding due to a defect in factors VIII, IX, XI  (8, 9, 11).

Abnormal PT alone is seen in:

• Bleeding due to a defect in Factor VIII (8).

Abnormal PTT + PT is seen in:

1. Anticoagulant therapy.
2. DIC.
3. Vit. K deficiency.
4. Liver diseases.
5. Rarely dysfibrinogenemia.
6. Rarely due to factor X, V, II defects.

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