10 Questions
What type of bleeding is characterized by bleeding from a single location?
Localized Hemorrhage
Which type of hemorrhage is manifested as bruises or purpura?
Mucocutaneous Hemorrhage
What type of symptoms are associated with disorders of primary hemostasis?
Menorrhagia, bleeding from the gums, hematemesis, epistaxis
Which type of hemorrhage is linked to acquired or congenital defects of secondary hemostasis?
Anatomic Hemorrhage
Where does Anatomic (Soft Tissue) Hemorrhage predominantly occur?
Internal: hemarthroses, body cavities, muscles, CNS
What is a distinguishing characteristic of congenital hemorrhage compared to acquired hemorrhage?
Not found in relatives
Which condition is most commonly associated with congenital hemorrhage?
Von Willebrand Disease (VWD)
What are the key elements that trigger Acute Coagulopathy of Trauma-Shock?
Hypoperfusion and acute inflammation
Which clotting factors are deficient in liver disease?
Vitamin K-dependent factors II, VII, IX, X
What is a common consequence of liver disease on platelet function?
Moderate thrombocytopenia due to sequestration and destruction
Study Notes
Hemorrhagic Coagulation Disorders
- Hemorrhage is severe bleeding that can be localized or generalized, acquired or congenital.
- Localized hemorrhage bleeds from a single location, while generalized hemorrhage bleeds from multiple sites.
- Generalized hemorrhage can be a disorder of primary/secondary hemostasis (coagulopathies) and may have a mucocutaneous or anatomic (soft tissue) pattern.
Mucocutaneous Hemorrhage
- Manifested as bruises or purpura (petechiae or ecchymoses).
- Disorder of primary hemostasis with symptoms including:
- Menorrhagia
- Bleeding from the gums
- Hematemesis
- Epistaxis
- Associated with thrombocytopenia, qualitative plt disorder, VWD, or vascular disorders.
Anatomic (Soft Tissue) Hemorrhage
- Acquired or congenital defects of secondary hemostasis (coagulation factor deficiencies).
- Mostly internal: hemarthroses, bleeding into body cavities, muscles, or the CNS.
Acquired vs. Congenital Hemorrhage
- Acquired hemorrhage:
- Began after infancy
- Associated with some disease or physical trauma
- Not duplicated in relatives
- Congenital hemorrhage:
- Uncommon
- Diagnosed in infants/young children
- Relatives with similar symptoms
- Most common: VWD, factor VIII and IX def, plt function disorders
Acquired Coagulopathies
- Acquired coagulopathies include:
- Liver disease
- Renal failure
- Vitamin K deficiency
- Autoanti-VIII Inhibitor and Acquired Hemophilia
- Acquired VWD
- DIC
- Acute Coagulopathy of Trauma-Shock
Acute Coagulopathy of Trauma-Shock
- Accounts for fatal hemorrhage
- Triggered by the combination of injury-related:
- Acute inflammation
- Plt activation
- TF release
- Hypothermia
- Acidosis
- Hypoperfusion
- All are elements of SYSTEMIC SHOCK
Liver Disease
- Liver disease can cause:
- Localized or generalized, mucocutaneous or anatomic bleeding
- Procoagulant deficiency (vitamin K-dependent factors: II, VII, IX, X and control proteins: C, S, Z)
- Factor V deficiency is a more specific marker of liver disease
- Platelet abnormalities:
- Moderate thrombocytopenia
- Due to plt sequestration and destruction
- DIC:
- Complication of liver disease
- Due to decreased production of regulatory proteins (AT, protein C and protein S)
- Also release of activated procoagulants from degenerating liver cells
- Acute/Uncompensated:
- PT, PTT, Thrombin time = ↑
- Fibrinogen
This quiz covers the symptoms of hemorrhagic coagulation disorders, focusing on the types of bleeding, whether localized or generalized, acquired or congenital. It also discusses distinctions between mucocutaneous and anatomic patterns of hemorrhage.
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