bleeding neonate / child
DESCRIPTION
clinical features and etiologyTRANSCRIPT
Bleeding neonate / child
CAUSES AND CLINICAL FEATURES
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
ETIOLOGY
Coagulation Disorders
Platelet Dysfunction
Vascular Fibrinolytic disorders
Coagulation DisordersInherited Acquired
• Hemophilia A and B• von Willebrand Disease• Factor VII, X, XIII
deficiency• Afibrinogenemia
• Liver disease• Vitamin K deficiency• Warfarin overdose• DIC
Platelet DysfunctionQuantitative Qualitative
• Decreased production• Increased destruction
• Inherited ▫ Glanzmann
thrombasthenia▫ Bernard Soulier
syndrome▫ Gray platelet syndrome▫ Wiskott Aldrich
syndrome• Acquired
▫ Medications▫ CRF▫ Cardiopulmonary
bypass
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
•Bone marrow failure syndromes▫Thrombocytopenia with absent radii▫Fanconi anemia
•Immunodeficiency syndromes▫Wiskott Aldrich syndrome
•Others ▫Hypersplenism, HUS, NAIT
Vascular causes
•Henoch Schonlein purpura•Connective tissue disorder•Scurvy •Prolonged steroid use•Hereditary hemorrhagic telangiectasia
CLINICAL FEATURES
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
OTHERS
•Mucosal bleeds•Joint or muscle bleed•Bleeding after minor trauma•Petechiae and purpurae•Ecchymoses•Fever with rash•Hepatosplenomegaly •Significant lymphadenopathy•Menorrhagia
HISTORY
•Age of onset•Sex •Frequency •Location / type of bleeding•Duration •Medications •Family history•Associated symptoms
Examination
•Pallor•Petechiae, ecchymoses, rashes•Hepatosplenomegaly•Local examination of mouth and nose•Lymphadenopathy•Features of bone marrow failure•Any associated features
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