Hemostasis & Bleeding disorders

Dairion Gatot, Savita Handayani

Divisi Hematology -Onkology Medic Internal Departement of Medical Faculty of North Sumatera University / Haji Adam Malik General Hospital, Medan 2011

HEMOSTASIS, (Virchows Triad)

Function of HEMOSTASIS
ARREST BLEEDING MAINTAIN BLOOD IN FLUID STATE

HEMOSTASIS
Primary Hemostasis
Blood vessel contraction Platelet Plug Formation

Secondary Hemostasis
Activation of Clotting Cascade Deposition & Stabilization of Fibrin

Tertiary Hemostasis
Dissolution of Fibrin Clot Dependent on Plasminogen Activation

Hemostasis
BV Injury
Tissue Factor

Lab Tests
CBC-Plt BT,(CT) PT PTT

Neural

Platelet Adhesion and Activation

Blood Vessel Constriction

Platelet Aggregation Primary hemostatic plug

Coagulation Cascade

Reduced Blood flow

Fibrin formation

Plt Study
Stable Hemostatic Plug

Morphology Function Antibody

Clinical Features of Bleeding Disorders

Platelet disorders Skin Mucous membranes (epistaxis, gum, vaginal, GI tract) Yes Small, superficial Extremely rare Yes Immediate, usually mild Coagulation factor disorders Deep in soft tissues (joints, muscles)

Site of bleeding

Petechiae Ecchymoses (bruises) Hemarthrosis / muscle bleeding Bleeding after cuts & scratches Bleeding after surgery or trauma

No Large, deep Common No Delayed (1-2 days), often severe

Vascular
Purpura, echymosis Connective tissue Ehler-Danlos Syndrome Aging process senile purpura (Batemans disease) Infectious Meningococcus Rocky Mountains syndrome typhoid fever Roseola spot Vit C deficiency scurvy Immunologic Henoch-Schonlein purpura

fragility capillary infectious, vasculitis

Platelet Disorders - Features:

Mucocutaneous bleeding Petechiae, Purpura, Ecchymosis. Spontaneous bleeding after trauma CNS bleeding (severe, plt) Prolonged bleeding time (BT)

Coagulation disorders:
Deficiencies of Clotting factors Onset - delayed after trauma Deep bleeding Into joints - Hemarthroses Into deep tissues Hematoma large skin bleed Ecchymoses

Coagulation Disorders
Laboratory findings: Normal bleeding time & Platelet count Prolonged prothrombin time (PT) deficiencies of II, V, VII, X Prolonged time (aPTT) all factors except VII, XIII Mixing studies - normal plasma corrects PT or aPTT

Disorders of Hemostasis
Vascular disorders
Scurvy, easy bruising, Henoch-Schonlein purpura.

Platelet disorders
Quantitative - Thrombocytopenia Qualitative - Platelet function disorders Glanzmans

Coagulation disorders
Congenital - Haemophilia (A, B), Von-Willebrands Acquired - Vitamin-K deficiency, Liver disease

Mixed/Consumption: DIC

VASCULAR

Senile Purpura

Henoch-Schonlein purpura

20y Male, fever, painful symmetric polyarthritis for a day. During the next two days, edema and palpable purpura developed.

Vascular
Non palpable purpura senile purpura scurvy use corticosteroid Palpable purpura Henoch-Schonlein syndrome

THE ROLE OF PLATELET IN HEMOSTASIS

THE ROLE OF PLATELET IN HEMOSTASIS

Dengue Hemorrhagic fever

Platelet deficiency..

Petechiae
(typical of platelet disorders)

Do not blanch with pressure (cf. angiomas) Not palpable (cf. vasculitis)

COAGULATION DISORDERS

Ecchymoses
(typical of coagulation factor disorders)

Platelet

Coagulation

Petechiae, Purpura

Hematoma, Joint bl.

Summary
Symptom Petechiae Sites Time Ecchymoses /Hematomas Platelet Yes Skin & Mucosa Immediate Yes Coagulation No Deep Tissue Delayed Yes