UNEXPLAINED HEMORRHAGE

Unexplained hemorrhage may result from inherited or acquired disorders of coagulation proteins or platelets. Patients with the onset of significant hemorrhage early in life usually have an inherited disorder such as hemophilia, while onset later in life or associated with serious illness such as sepsis or malignancy usually signifies an acquired disorder such as disseminated intravascular coagulation or thrombocytopenia of other causes. Disorders such as immune thrombocytopenic purpura (ITP) and Factor VIII inhibitors may present without apparent prior illness. The evaluation of a patient with a hemorrhagic diathesis must proceed in an algorithmic manner to determine the precise etiology of hemorrhage. Treatment may vary greatly from acute intervention with factor replacement and platelets treatment for high-risk events.

Hemorrhagic Diatheses

• Fibrinogen defects (factor II)(dysfunctional and deficiency state)
• Factor VIII:C defects (inhibitor, deficiency)
• Factor IX defects (dysfunctional and deficiency)
• Factor X defects
• Factor XII defects
• Factor XIII defects
• High Molecular Weight Kininogen defects
• Von Willebrand’s disease
• Thrombocytopenia
• Platelet storage pool disease
• Glanzman’s thrombasthenia
• Bernard Soulier syndrome
• Hereditary Hemorrhagic Telangiectasia
• Disseminated Intravascular Coagulation
• Primary Fibrinolysis
• Thrombotic Thrombocytopenic Purpura
• Henoch Schoenlein Purpura
• Hemolytic Uremic Syndrome