mucosal bleeding
Introduction
Introduction The bleeding point of the mucous membrane is caused by the body's hemostasis or coagulopathy. It is usually characterized by spontaneous bleeding of the systemic or localized skin and mucous membranes or difficult to stop bleeding after injury.
Cause
Cause
1. abnormal blood vessel wall function Under normal circumstances, when the blood vessel is damaged, the local small blood vessels will have a reflective contraction, which will make the blood flow slower, so as to facilitate the early hemostasis, and then, under the action of serotonin such as angiotensin released by platelets, Make the capillaries shrink longer and play a hemostatic effect. When there is a congenital defect or damage to the capillary wall, it can not normally contract to exert hemostasis, and the skin and mucous membrane bleeding is common in:
(1) Heritage hemorrhagic telangiectasia, vascular pseudohemophilia.
(2) Allergic purpura, simple purpura, senile purpura and mechanical purpura.
(3) Severe infection, chemical or drug poisoning and metabolic disorders, vitamin C or vitamin PP deficiency, uremia, arteriosclerosis, etc.
2. Platelet abnormal platelets play an important role in the process of hemostasis. At the vascular injury, platelets adhere to each other and aggregate into white thrombus to block the wound. Platelet membrane phospholipids release arachidonic acid under the action of phospholipase, and then convert to thromboxane (TXA2), further promote platelet aggregation, and have strong vasoconstriction, promoting local hemostasis. When the number or function of platelets is abnormal, it can cause skin and mucous membrane bleeding, which is common in:
(1) Thrombocytopenia:
1 reduction in platelet production: aplastic anemia, leukemia, infection, drug inhibition, and the like.
2 excessive platelet destruction: idiopathic thrombocytopenic purpura, drug-induced thrombocytopenic purpura.
3 excessive platelet consumption: thrombotic thrombocytopenic purpura, diffuse intravascular coagulation.
(2) thrombocytosis: 1 primary: essential thrombocytosis; 2 secondary: secondary to chronic myeloid leukemia, splenectomy, infection, trauma and so on. Although the number of platelets in such diseases increases, it can still cause bleeding imaginary, which is caused by slow activity of active thromboplastin or abnormal platelet function.
(3) Abnormal platelet function:
1 hereditary: thrombocytosis (mainly aggregation abnormalities), thrombocytosis (thormbopathy) (mainly platelet factor 3 abnormalities).
2 secondary: secondary to drugs, uremia, liver disease, abnormal globulinemia.
3. Coagulation dysfunction The coagulation process is complex, and many coagulation factors are involved. Any lack of coagulation factors or insufficient function can cause coagulopathy, leading to the appearance of skin and mucous membranes.
(1) Hereditary: hemophilia, hypofibrinogenemia, prothrombin deficiency, hypoprothrombinemia, coagulation factor deficiency, etc.
(2) Secondary: severe liver disease, uremia, vitamin K deficiency.
(3) Increased anticoagulant substances or hyperfibrinolysis in circulating blood: abnormal proteinemia, increased heparin anticoagulant substances, excessive anticoagulant therapy, primary fibrinolysis or disseminated intravascular coagulation secondary fibers Dissolved.
Examine
an examination
Related inspection
Platelet volume distribution width (PDW) Partial thromboplastin time Coagulation factor activity assay (Factor VIII: C, IX: C)
The bleeding point of the mucous membrane appears as blood deposits on the skin or under the mucous membrane, forming red or dark red spots, and the pressure does not fade. The size of the bleeding area can be divided into sputum spots, purpura and ecchymoses. Thrombocytopenic hemorrhage is characterized by bleeding at the same time, purpura and ecchymosis, nosebleeds, bleeding gums, menorrhagia, hematuria and melena, which can cause cerebral hemorrhage. Patients with platelet disease have normal platelet counts and mild hemorrhage. They are mainly subcutaneous, nosebleed and menorrhagia, but bleeding can occur during surgery.
The bleeding caused by abnormal function of the blood vessel wall is characterized by sputum and ecchymosis of the skin and mucous membranes. For example, allergic purpura is characterized by symmetry of the limbs or arms, and higher than the skin (urticaria or papule-like) purpura, which may be accompanied by itching. , joint pain and abdominal pain, may have hematuria when the kidneys are involved. Senile purpura is often the lateral ecchymosis of the hands and feet; simple purpura is the occasional ecchymosis of the chronic limbs, which is common in the menstrual period of female patients. Hemorrhage caused by coagulopathy is often characterized by visceral, muscle bleeding or soft tissue hematoma, and often has joint cavity bleeding, and often has a family history or liver history.
Diagnosis
Differential diagnosis
Comprehensive judgment is made based on the accompanying symptoms of the patient's body:
1. Symmetrical purpura with limbs associated with joint pain and abdominal pain, hematuria, found in allergic purpura.
2. Purpura with extensive hemorrhage, such as nosebleeds, bleeding gums, hematuria, melena, etc., seen in thrombocytopenic purpura, diffuse intravascular coagulation.
3. Aster is accompanied by jaundice and is found in liver disease.
4. Hemorrhage after a minor injury from childhood, and joint swelling or pain, seen in hemophilia.
