Bleeding (Excessive)

• Initial laboratory tests include CBC with peripheral smear, platelet count, PT/INR (evaluates extrinsic pathway—factors X, VII, V, II, I), PTT (evaluates intrinsic pathway—XII, XI, IX, VIII, V, II, I), thrombin time (measures ability of thrombin to transform fibrinogen in fibrin), bleeding time (evaluates platelet function and capillary integrity), and urinalysis (for hematuria)
• Additional tests may be indicated
  –Fibrinogen assay
  –Urea clot lysis test (evaluates factor XIII deficiency)
  –Mixing studies (determines the presence of an anticoagulant in the blood)
  –Specific factor assays
  –Platelet adhesion and aggregation tests (to evaluate platelet function)
  –Bone marrow aspirate (to evaluate platelet production and rule out leukemia)
• Hematology consultation is often indicated

Treatment

• Initial, emergent intervention with supplemental O₂, rapid IV hydration, hemostasis (usually with direct pressure), and transfusion is necessary with brisk bleeding and/or hemodynamic compromise
• Remove offending medications (e.g., heparin)
• Uremia: DDAVP, cryoprecipitate, and treatment of renal disease
• Vitamin K deficiency: Administer parenteral vitamin K
• DIC: Treat underlying cause, administer fresh frozen plasma and cryoprecipitate
• HSP: Corticosteroids for severe cases
• von Willebrand's disease and hemophilia A: DDAVP for mild bleeding, factor VIII concentrate, cryoprecipitate
• ITP: Corticosteroids, splenectomy, IVIG in emergency
• HIT: Stop heparin
• Liver disease: Fresh frozen plasma, tranexamic acid to control epistaxis or gum bleeding, treat liver disease if possible

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

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More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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