Bleeding disorders  by 小恩恩

1. Structural causes: injury to the tissue or organ/ abnormality of the tissue

2. Platelet-related causes (usually small vessel bleeding: petechiae, bruising, gum
bleeding, or nosebleeds)
 通常不會失血很多(到需要輸血的程度)
 危險 if: 腦內出血、狂咳嗽導致 abdominal hematoma (rare)
I. Thrombocytopenia
a. Production 減少: medications [valproic acid, linezolid, thiazides, gold
compounds, antineoplastic chemotherapy drugs], bone marrow
replacement by [malignancy, fibrosis, granulomas], BM aplasia,
suppression of megakaryocyte production by alcohol abuse, B12 缺乏
(pancytopenia)
b. Loss 變多/consumption 變多: splenic sequestration(plt 通常>4 萬),
autoimmune thrombocytopenia [idiopathic(ITP), HIV, SLE,
lymphoproliferative disorders, Hepatitis C, medications(heparin,
phenytoin, carbamazepine, sulfonamide, quinine, antiplatelet drugs
{abciximab/tirofiban}) ], DIC, TTP, sepsis
II. Platelet dysfunction
a. Congenital: vWF dz, other rare genetic
b. Acquired: medications [aspirin, NSAIDs, clopidogrel],
myeloproliferative disorders (essential thrombocythemia,
polycythemia vera), coating of platelets by abn proteins (plasma cell
myeloma, immune thrombocytopenia), uremia
3. Clotting factor-related causes
 較 delayed (因為 platelet 先塞住，但 fibrin clot 沒加強)
 失血量較多
 常見: joints, GI tract, retroperitoneum, 最近 injury/surgical site
I. Congenital: hemophilia A(最常見), other clotting factor deficiencies
II. Acquired:
a. Factor/ factors 缺乏: liver dz, vit K 缺乏(nutrition or warfarin),
abnormal adsorption of a factor (eg, factor X adsorption to amyloid
fibrils), consumption of factors (DIC), dilution of factors(爆多輸液)
b. Inhibitor to clotting factor/factors