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Coagulation – part 2 – Coagulation Screening, Work up of Bleeding Disorder

Coagulation – part 2 – Coagulation Screening,  Work up of Bleeding Disorder
September 16, 2020HematologyLab Tests

Definition of bleeding disorders:

  1. Before we start work up of bleeding disorder we should understand two systems of bleeding.
  2. Bleeding disorders may be of two types:
    1. Primary hemostasis, related to:
      1. Platelets.
      2. Vascular defects.
    2. Secondary hemostasis related to:
      1. Coagulation factors defects.

Table to differentiate two types:

Clinical feature Primary Hemostasis Secondary Hemostasis
Onset time Immediately after trauma Late after trauma
Clinical presentation Petechiae, Ecchymosis Hematoma
Sites Mucous membrane, skin Deep Tissue
Joints, Muscles, CNS
Mucous membranes Nasal, oral, GIT, urinary Less common
Examples Thrombocytopenia Factors deficiency
Willebrand disease Liver disease
 Platelets defect Acquired inhibitors

Bleeding disorder test profile consists of:

1. Platelets.
2. Bleeding time.
3. Clotting time.
4. APTT.
5. PTT.
6. PT.
7.Clotting factor assay.

Platelets abnormality is seen in :

  1. Idiopathic thrombocytopenia.
  2. Low due to drugs.
  3. Hypersplenism.
  4. SLE.
    • (See more in Platelets)

Abnormal PTT alone is seen in:

  • Bleeding due to a defect in factor VIII, IX, XI  (8, 9, 11).

Abnormal PT alone is seen in:

  • Bleeding due to a defect in Factor VIII (8).

Abnormal PTT + PT is seen in:

  1. Anticoagulant therapy.
  2. DIC.
  3. Vit.K deficiency.
  4. Liver diseases.
  5. Rarely dysfibrinogenemia.
  6. Rarely due to factor X, V, II defects.

 


Possible References Used
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