Download MBBS Pediatric PPT 1 Bleeding And Suspected Malignancy Lecture Notes

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