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

Definition of bleeding disorders:
- Before we start work up of bleeding disorder we should understand two systems of bleeding.
- Bleeding disorders may be of two types:
- Primary hemostasis, related to:
- Platelets.
- Vascular defects.
- Secondary hemostasis related to:
- Coagulation factors defects.
- Primary hemostasis, related to:
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 :
- Idiopathic thrombocytopenia.
- Low due to drugs.
- Hypersplenism.
- 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:
- Anticoagulant therapy.
- DIC.
- Vit.K deficiency.
- Liver diseases.
- Rarely dysfibrinogenemia.
- Rarely due to factor X, V, II defects.