bleeding neonate / child
DESCRIPTION
clinical features and etiologyTRANSCRIPT
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Bleeding neonate / child
CAUSES AND CLINICAL FEATURES
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Hemostasis
INJURY
Collagen Exposure
Platelet Adhesion and release reaction
Platelet aggregation
VASOCONSTRICTION
Serotonin Platelet Phospolipid
Thromboxane A2 ADP
Primary haemostatic plug
Stable haemostatic plug
Tissue Factor
Coagulation
Thrombin
Fibrin
Fibrinolysis
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ETIOLOGY
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Coagulation Disorders
Platelet Dysfunction
Vascular Fibrinolytic disorders
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Coagulation DisordersInherited Acquired
• Hemophilia A and B• von Willebrand Disease• Factor VII, X, XIII
deficiency• Afibrinogenemia
• Liver disease• Vitamin K deficiency• Warfarin overdose• DIC
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Platelet DysfunctionQuantitative Qualitative
• Decreased production• Increased destruction
• Inherited ▫ Glanzmann
thrombasthenia▫ Bernard Soulier
syndrome▫ Gray platelet syndrome▫ Wiskott Aldrich
syndrome• Acquired
▫ Medications▫ CRF▫ Cardiopulmonary
bypass
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Thrombocytopenia
•ITP•TORCH•Infections
▫Kala azar, DHF, malaria, hepatitis B and C, HIV
•Medications▫Valproate, penicillins, heparin, quinine,
digoxin•Malignancies
▫Leukemia, lymphoma, neuroblastoma•Collagen vascular disorders
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•Bone marrow failure syndromes▫Thrombocytopenia with absent radii▫Fanconi anemia
•Immunodeficiency syndromes▫Wiskott Aldrich syndrome
•Others ▫Hypersplenism, HUS, NAIT
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Vascular causes
•Henoch Schonlein purpura•Connective tissue disorder•Scurvy •Prolonged steroid use•Hereditary hemorrhagic telangiectasia
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CLINICAL FEATURES
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NEONATES
•Oozing from umbilical stump•Cephalhematoma•Bruising, petechiae•Bleeding from site for venipuncture or
procedure site•Bleeding from scalp•Intracranial hemorrhage•Bleeding from mucous membranes
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OTHERS
•Mucosal bleeds•Joint or muscle bleed•Bleeding after minor trauma•Petechiae and purpurae•Ecchymoses•Fever with rash•Hepatosplenomegaly •Significant lymphadenopathy•Menorrhagia
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HISTORY
•Age of onset•Sex •Frequency •Location / type of bleeding•Duration •Medications •Family history•Associated symptoms
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Examination
•Pallor•Petechiae, ecchymoses, rashes•Hepatosplenomegaly•Local examination of mouth and nose•Lymphadenopathy•Features of bone marrow failure•Any associated features
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Platelet vs coagulation disordersPlatelet Disorder Coagulation
Disorder
Site Skin, mucous membranes
Deep in soft tissues, joint, muscles
Petechiae Yes No
Ecchymoses Small, superficial Large, deep
Bleeding after minor trauma
Yes No
Bleeding after surgery
Immediate, mild Delayed, severe
Examples von Willebrand disease, ITP
Hemophilia A and B