Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Pediatric PPT 1 Bleeding And Suspected Malignancy Lecture Notes
Approach to child with
bleeding and coagulation
disorder
Learning objectives
? To recognize causes of bleeding in children
? To recognize importance of history and examination
? To differentiate between platelets and coagulation disorders
Introduction
? Bleeding is a diagnostic challenge in children
? Excessive bleeding suggest underlying bleeding disorder
? Minor bleeding is common in children
? Bleeding disorder can be inherited or acquired
? Coagulation, vascular disorder and platelet deficiency are main
bleeding disorder
? Evaluation include history, exam and lab tests
Types of Bleeding Disorders
? Coagulation Disorders- congenital/ acquired
? Hemophilia A (factor VII deficiency)
? Hemophilia B (factor IX deficiency)
? von Willebrand Disease (vWD)
? Other
? Platelet disorders
? Thrombocytopenia
? Platelet functional defect
? Vascular
? HSP
? Connective tissue disorder
? Scurvy
History
? Detailed history
? Types of bleeding
? Emphasis on the child's age, sex, clinical presentation, family history
? General medical history: Malignancy, Sepsis, Drug use, Liver disease
etc
Physical examination
? Petechiae: Small pinhead hemorrhagic spot <3 mm
? Purpura (latin mean purple): Red or purpuric discoloration of skin
that do not blanch on pressure, size 3-10 mm
? Ecchymosis: size >1 cm
? Hematoma: Collection of blood under skin or muscle of more than 1
cm
? Hemarthrosis: Collection of blood in joints
Physical examination
? Mucocutaneous bleeding suggests a disorder of primary hemostasis,
i.e. VWD or platelet dysfunction/deficiency, or a vascular disorder.
? In males, deep hematomas, hemarthroses, or evidence of chronic
joint abnormalities suggests hemophilia
? Acquired bleeding disorders may present in the context of coexisting
illness
? Anemia
? Thrombocytopenia
? Loose joints and lax skin
Physical examination
? Lymphadenopathy and/or organomegaly suggest an infiltrative
process such as malignancy or a storage disease.
? Signs of liver failure suggest acquired coagulation factor deficiencies
? Additional congenital anomalies may suggest the presence of a
syndromic bleeding disorder
Clinical features of bleeding disorder
Clinical sign/ symptoms
Platelet/ vascular
Coagulation factor
abnormality
deficiency
Ecchymosis
Small and superficial
Large and deep
Petechiae
Frequent
Never
Mucosal haemorrhage
Frequent
Uncommon
Muscle/ joint or internal
Uncommon
Frequent
hemorrhage
Bleeding after trauma/
Immediate, stops with
Delayed(1-2 d later) does
surgery
pressure
not stop with pressure
Example
vWD, ITP
Hemophilia A and B
FOR INT
Laboratory investigations
? CBC
? Peripheral smear
? Bleeding time ? platelet no/ functions
? PT- (12?2 sec, 2, 5, 7, 10)
? aPTT- (25-40 sec- 5, 8, 9, 10, 11, 12)
? Platelet function testing
FOR INTERNAL USE ONLY !
GC
BT
PT
APTT
P/C
Diagnosis
Wel
N
N
N
Hemophilia A
and B
Wel
N
N
N
Factor 7
deficiency
Wel
N
N
Vitamin K
deficiency
Sick
DIC, Liver
disease
Wel
N
N
ITP
Sick
N
N
Aplastic
anemia,
leukemia
Wel
N
N
N
Qualitative
platelet defect
Lab workup
History and physical examination
PT & APTT
Platelets
decreased
Infections
Hypersplenism
ITP
Abnormal PT,
Malignancy
Abnormal
Abnormal PT
Normal APTT
CHD
APTT
and APTT
Anticoagulant
Fanconi anemia
Normal PT
Oral
therapy
TAR
Hemophilia
anticoagulant,
A and B
Factor VI def
liver dysfunction
Vit K def, DIC
vWD
Clinical manifestations of hemophilia
Hemophilia can affect any organ in the body
Early symptoms
From Childhood
? Blue patches and bruises on the skin.
? Gum bleeds
? Frenulum bleeds.
? Cuts and Wounds which Bleed a long time.
Early symptoms
? Unbearable pain in Muscles and joints
? Swelling.
? With out Injury
HSP: Typical rash
Quiz
Q1. Al of fol owing are true except
a) Intrinsic pathway of coagulation can be determined by PT
b) PT is increased in hemophilia
c) Platelets are normal in HSP
d) None
This post was last modified on 07 April 2022