bleeding disorders
Introduction
Introduction to bleeding disorders When the hemostatic function of the human body can cause obstacles, it can cause spontaneous bleeding or slight damage to the skin, mucous membranes and internal organs, that is, bleeding, and any disease with such bleeding tendency can be called hemorrhagic disease. The tendency of bleeding is a common manifestation of many different diseases and different causes of bleeding. In order to clarify the reasons, clinical and laboratory data must be comprehensively analyzed to understand the past history of patients and to combine the current bleeding conditions to reach correct conclusions. Laboratory tests are more important. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific people Mode of infection: non-infectious Complications: anemia shock
Cause
Causes of bleeding disorders
Vascular abnormalities (30%):
Including abnormal blood vessels and abnormalities caused by extravascular factors, hemorrhagic diseases, allergic purpura, vitamin C deficiency, hereditary telangiectasia, etc. are caused by abnormal blood vessels themselves, senile purpura, homocystinuria, etc. Caused by extravascular abnormalities.
Platelet abnormalities (30%):
Changes in platelet count and adhesion, aggregation, release response and other dysfunction can cause bleeding, idiopathic thrombocytopenic purpura, drug-induced thrombocytopenia and thrombocytopenia, all of which are hemorrhagic diseases caused by abnormal platelet counts. , thrombocytopenia, giant platelet disease, etc. are bleeding disorders caused by platelet dysfunction.
Abnormal clotting factor (30%):
Including both congenital clotting factors and acquired clotting factor abnormalities, such as hemophilia A (lack of factor VIII) and hemophilia B (absence of factor IX) are chromosomal recessive inherited bleeding disorders, vitamin K deficiency Most of the bleeding caused by liver diseases is caused by abnormal clotting factors.
Prevention
Hemorrhagic disease prevention
Hemorrhagic diseases can be divided into two types, one is hereditary hemorrhagic disease related to hereditary factors, the family has a genetic history, and the other is a secondary hemorrhagic disease, which is caused by adverse stimulation of acquired factors. Abnormal function of the body, regardless of which hemorrhagic disease, is characterized by bleeding tendency or bleeding, and more often in the patient's life, should pay attention to the daily life of the family:
1. Drugs that are frequently exposed to life, such as aspirin, dipyridamole, indomethacin, phenylbutazone, and dextran, are unsafe drugs for patients with bleeding disorders because they inhibit platelet aggregation and dilate blood vessels. Can increase bleeding.
2. Pay attention to diet, eat more fruits and vegetables containing more vitamin C in food selection, and pay attention to cooking methods, avoid hard foods, such as fish, bones, etc., so as not to accidentally puncture the mucous membrane of the digestive tract, causing Bleeding.
3. Protect the skin and mucous membranes. Patients should reduce the irritation to the skin and mucous membranes. When brushing your teeth, use a soft-bristled toothbrush or a cotton ball to avoid damage to the gums, causing bleeding. The clothes should be slightly wider. Avoid sharpness when exercising. Tools, try to avoid collisions between limbs and external objects, prevent skin damage and subcutaneous bleeding.
4. If traumatic hemorrhage occurs at home, try to take pressure to stop bleeding, and limit the joint activity of the bleeding site. The hemostasis method has pressure bandage to stop bleeding, dry towel and handkerchief cover the wound pressure bandage; finger pressure hemostasis, with fingers, The palm or fist presses the end of the bleeding artery close to the heart, which can cut off the blood flow and achieve the purpose of temporarily stopping bleeding. If it can not achieve complete hemostasis in a short time, you should go to the hospital for treatment.
5. Prevent cross-infection at home. Cross-infection is a common cause of secondary infection of blood diseases. When relatives and friends suffer from respiratory infections or other infectious diseases, avoid contact with patients and keep the indoor environment clean.
Complication
Hemorrhagic disease complications Complications anemia shock
A common complication of chronic hemorrhagic disease is anemia; acute hemorrhagic disease can be complicated by shock or even death.
Symptom
Hemorrhagic disease symptoms Common symptoms Abdominal pain Menstrual flow more bleeding tendency jaundice thrombocytopenia telangiectasia Hepatosplenomegaly vasospasm lymph node enlargement
The tendency of bleeding is a common manifestation of many different diseases and different causes of bleeding. In order to clarify the reasons, clinical and laboratory data must be comprehensively analyzed to understand the past history of patients and to combine the current bleeding conditions to reach correct conclusions. Laboratory tests are more important.
(1) To examine the history of hemorrhagic diseases, such as bleeding from childhood, minor injuries, bleeding after trauma or minor surgery, should be considered as hereditary hemorrhagic disease; adulthood should consider the acquisition of bleeding, need to find the original Onset; skin, mucous membrane purpura with abdominal pain, joint pain and normal platelets should consider allergic purpura; skin mucosa purpura, menstrual volume, low platelet count need to consider thrombocytopenic purpura, more women.
(2) Physical examination should pay attention to the traits and parts of bleeding. Allergic purpura occurs in both lower limbs and buttocks. The size is different, symmetrically distributed, and may be accompanied by rash and urticaria, thrombocytopenic purpura or platelet dysfunction. Sexual diseases are often needle-like bleeding points, with a systemic scattered distribution.
Scurvy is characterized by peri-hair follicle bleeding, hereditary telangiectasia with lips, vasospasm in the tongue and cheeks, hepatosplenomegaly, lymphadenopathy, jaundice, etc., can provide clinical diagnosis of primary disease.
Examine
Examination of bleeding disorders
(1) Determination of platelet adhesion function.
(2) Determination of platelet aggregation function.
(3) Prothrombin consumption test. Under physiological conditions, blood coagulation requires a large amount of prothrombin, and there is little prothrombin remaining in the serum after coagulation, and the serum prothrombin time is prolonged. If the blood coagulation factors VIII, IX, XI, and XII are defective, the production of thromboplastin is poor, and the consumption of prothrombin is reduced. Therefore, more prothrombin remains in the serum, and the prothrombin time is shortened.
(4) Blood coagulation enzyme production test.
(5) Determination of thrombin time.
(6) Determination of clotting factor activity.
Diagnosis
Diagnostic identification of hemorrhagic diseases
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Hemorrhagic diseases are mainly the differential diagnosis between the etiology and classification, such as hemorrhagic diseases caused by vascular factors, hemorrhagic diseases caused by platelet factors, hemorrhagic diseases caused by abnormal blood coagulation factors, and hemorrhagic diseases caused by excessive fibrinolysis. Differential diagnosis between hemorrhagic diseases caused by circulating anticoagulant substances.
