Bleeding conditions (pediatrics)

Classification of bleeding conditions

Bleeding conditions from blood clotting disorders

• Thrombocytopenia
  • thrombocytopenia from reduced production,
    • TAR syndrome,
    • Wiskott-Aldrich syndrome,
    • aplastic anemia,
    • cyanotic heart defects,
    • drug-induced thrombocytopenia (antiepileptics – valproate, cytostatics, heparin,…),
  • thrombocytopenia from increased destruction,
    • neonatal alloimmune thrombocytopenic purpura (NATP),
    • newborns of mothers with autoimmune thrombocytopenic purpura (autoantibodies can cross the placenta,
    • acute autoimmune (idiopathic) thrombocytopenic purpura (ITP),
    • chronic autoimmune thrombocytopenic purpura,
    • thrombotic thrombocytopenic purpura (TTP),
• thrombocytopathy – prolonged bleeding with a normal platelet count,
  • congenital coagulopathy,
    • hemophilia,
    • von Willebrand disease,
  • acquired coagulopathy,
    • vitamin K deficiency coagulopathy in a newborn,
    • disseminated intravascular coagulation.

Bleeding conditions from vascular disorders

Bleeding conditions characterized by a hemostasis disorder at the site of damage to small vessels without disorders of the coagulation system.

• congenital disorders of the vascular wall,
  • hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease),
  • ataxia telangiectasia,
• acquired vascular wall disorders – vasculitis,
  • Henoch-Schönlein purpura,
  • Kawasaki disease,
  • Polyarteritis nodosa,
  • Wegener's granulomatosis,
  • secondary vasculitis (in SLE, in infections, in scurvy).

Differential diagnosis of clinical manifestations of hemorrhagic diatheses

coagulopathy

• deep localization → bleeding into muscles, joints,
• bleeding is delayed/protracted,
• it returns even after a few hours, it cannot be easily stopped by local compression,
• the scope is more about isolated manifestations.

thrombocytopenia /thrombocytopathy

• surface localization → petechiae (they are in niveau), suffusion, bleeding from mucous membranes,
• bleeding is immediate,
• compression can be easily stopped,
• the range usually involves multiple manifestations.

vasculopathy

• bleeding with a character similar to thrombocytopenia / -pathies,
• often symmetrical distribution,
• can come in waves,
• on the skin at the same time exanthems, edemas, possibly necrosis,
• petechiae are palpable = above niveau skin.

Differential diagnosis of thrombophilic conditions

Leiden mutation

congenital thrombophilic conditions

• AT III deficiency,
• protein C deficiency,
• protein S deficiency,
• resistance to activated protein C (= disorder of binding of protein C to f. V, the so-called Leiden mutation, which occurs in up to 5% of the population).

acquired thrombophilic states

• vascular catheters,
• vasculitis,
• diabetes mellitus,
• hyperhomocysteinemia,
• dehydration ,
• hyperviscosity: polycythemia, extreme leukocytosis,
• thrombocytosis,
• hyperlipidemia,
• malignancy,
• p.o. contraception,
• nephrotic syndrome,
• HUS,
• antiphospholipid syndrome

Links

related articles

• Hemostasis disorders: Hereditary coagulopathy • Acquired coagulopathy • Hemorrhagic diatheses (pathology) • Thrombocytopathy
• Hemostasis • Haemocoagulation • Examination of blood coagulation • Examination of bleeding