tailieunhanh - Chapter 059. Bleeding and Thrombosis (Part 4)

Approach to the Patient: Bleeding and Thrombosis Clinical Presentation Disorders of hemostasis may be either inherited or acquired. A detailed personal and family history is key in determining the chronicity of symptoms and the likelihood of the disorder being inherited and it provides clues to underlying conditions that have contributed to the bleeding or thrombotic state. In addition, the history can give clues as to the etiology by determining (1) the bleeding (mucosal and/or joint) or thrombosis (arterial and/or venous) site, and (2) whether an underlying bleeding or clotting tendency was enhanced by another medical condition or the introduction of. | Chapter 059. Bleeding and Thrombosis Part 4 Approach to the Patient Bleeding and Thrombosis Clinical Presentation Disorders of hemostasis may be either inherited or acquired. A detailed personal and family history is key in determining the chronicity of symptoms and the likelihood of the disorder being inherited and it provides clues to underlying conditions that have contributed to the bleeding or thrombotic state. In addition the history can give clues as to the etiology by determining 1 the bleeding mucosal and or joint or thrombosis arterial and or venous site and 2 whether an underlying bleeding or clotting tendency was enhanced by another medical condition or the introduction of medications or dietary supplements. History of Bleeding A history of bleeding is the most important predictor of bleeding risk. In evaluating a patient for a bleeding disorder a history of at-risk situations including the response to past surgeries should be assessed. Does the patient have a history of spontaneous or trauma surgery-induced bleeding Spontaneous hemarthroses are a hallmark of moderate and severe factors VIII and IX deficiency and in rare circumstances of other clotting factor deficiencies. Mucosal bleeding symptoms are more suggestive of underlying platelet disorders or von Willebrand disease vWD termed disorders of primary hemostasis or platelet plug formation. Disorders affecting primary hemostasis are shown in Table 59-1. Table 59-1 Primary Hemostatic Platelet Plug Disorders Defects of Platelet Adhesion von Willebrand disease Bernard-Soulier syndrome absence of dysfunction of GpIb-IX-V Defects of Platelet Aggregation Glanzmann s thrombasthenia absence or dysfunction of GpIIbIIIa Afibrinogenemia Defects of Platelet Secretion Decreased cyclooxygenase activity Drug-induced aspirin nonsteroidal anti-inflammatory agents Inherited Granule storage pool defects Inherited Acquired Nonspecific drug effects Uremia Platelet coating . paraprotein penicillin