Bleeding conditions (pediatrics)

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
thumb|right|Leidenská mutace
 * 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

Reference

 * 1) BENEŠ, Jiří. Studijní materiály [online]. [cit. 2011]. < http://jirben.wz.cz >.
 * 2) HAVRÁNEK, Jiří: Hematologie - obecný úvod. (upraveno).

related articles

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