The approach to a patient with a bleeding disorder needs a comprehensive detailed history and thorough physical examination. Develop a diagnostic algorithm for evaluating patients. Evaluation of vaginal bleeding approach bmj best practice. Jan 01, 2005 diagnosis and management of congenital and acquired bleeding disorders in children requires not only an understanding of the unique characteristics of pediatric hemostasis but also the natural course of bleeding disorders in children, which may differ substantially from the course observed in adult patients. Practical stepwise approach to understanding and investigating anemia and bleeding disorders is illustrated. In summary, approach to diagnosis of bleeding disorder in a child relies heavily on a detailed clinical history and thorough clinical examination. Approach to patients with bleeding disorders in the emergency. Introduction bleeding, technically known as hemorrhaging, is the loss of blood escaping from the circulatory system. Kraut, md, the ohio state university, columbus, ohio n umerous disorders can cause abnormal. Jan 01, 2012 terms associated with abnormal uterine bleeding are inconsistently defined in the literature, complicating the approach to evaluation and management. Causes of bleeding could be trivial or secondary to an underlying bleeding disorder or a potentially serious systemic illness. Neonatal coagulation disorders background and pathophysiology. Peptic ulcer disease treatment approach epocrates online.
The onset of discoloured urine, including urine that is turbid, pink, brown or bloody. An approach to identifying the most likely coagulation disorders is presented. Diagnosis and management of congenital and acquired bleeding disorders in children requires not only an understanding of the unique characteristics of pediatric hemostasis but also the natural course of bleeding disorders in children, which may. The aim of this first communication is to define the basis of a systematic, uniform approach to mbds and to provide a consensus on the principles underlying the following guidelines that will be specifically dedicated to. Evaluation of vaginal bleeding should include a detailed history of the nature and extent of bleeding. Urinary symptoms that are associated with an abnormal urine dipstick test. Bleeding disorder, clinical history, laboratory tests. Describe the clinical features suggestive of an underlying bleeding disorder. Based on etiology, they can be categorized into disorders affecting platelets or the coagulation cascade and can be inherited or acquired. Congenital bleeding disorders and itp usually occur in children who are otherwise well.
Symptoms such as bruising and epistaxis occur frequently in children without underlying bleeding disorders, and so determin ing which. A clinical casebook is a valuable resource for clinicians and practitioners treating patients with challenging coagulation issues. A state of general wakefulness and responsiveness to environment. Pipettes should preferably be accurate within signifi cantly less than 10%. Approach to the child with bleeding symptoms uptodate.
Joint bleeding is infrequent at this age, but mouth bleeds and head bumps are common. Ppt approach to bleeding disorders powerpoint presentation. A bleeding disorder, usually inherited, characterized by the deficiency of coagulation factor viii or ix. Evaluation for bleeding disorders in suspected child abuse. Approach to the comatose child background definitions consciousness. Examples of bleeding include intracranial hemorrhage, deep muscle and joint hemorrhage, hematomas, retroperitoneal hemorrhage, bleeding following teeth extraction, postsurgical bleeding, easy bruising and mucosal bleeding. The age and developmental capabilities of the child, history of trauma, the location and pattern of bruising, and, in the case of ich, findings on neuroimaging should be considered when assessing children with bruisingbleeding for possible abuse. Bleeding issues in neonates and infants update 2015. Pdf approach to a child with bleeding in the emergency room. A bleeding child is a cause of great concern and often, panic, for parents and pediatricians alike. A diagnostic workup michael ballas, md, wilson care, fort loramie, ohio eric h. When evaluating a child with a potential bleeding disorder, it is extremely crucial to ascertain whether the patients symptoms are appropriate to a bleeding disorder and whether further investigation of an underlying bleeding disorder is required.
A healthy child with normal clotting studies will rarely have a deficiency of factor xlii fibrinstabilizing factor, which could result in a bleeding disorder characterized by delayed localized. Approach to a child with bleeding disorder seminar 1. Bruising and bleeding in infants and children a practical approach. Child development with a bleeding disorder and transition. Bleeding history usually clear in patients with severe bleeding disorders in patients with mildmoderate bleeding symptoms a standardized questionnaire is helpful standardized scores to. Three exposures per day is the recommended maximum. Approach to patients with bleeding disorders in the. Approach to a child with bleeding disorder seminar 1 free download as powerpoint presentation. Pdf diagnostic approach to inherited bleeding disorders. Apr 19, 2012 the nature of the bleeding should be explored in addition to a family history and pedigree, and a careful examination with appropriate screening tests.
Classification of coagulation disorders in children. Bleeding disorders is a general term for a wide range of medical problems that lead to. Guidelines for dental treatment of patients with inherited bleeding disorders 3 the consumption of foods and drinks with a high sugar or acid content should be limited to mealtimes. Active gastrointestinal bleeding requires urgent evaluation. Neonatal bleeding results from disorders of platelets, coagulation proteins, and disorders of vascular integrity. Written by experts in the field, pediatric bleeding disorders. A systematic approach employing the following questions can help to reach a more precise clinical diagnosis. The approach to a suspected bleeding disorder in children and adolescents is discussed separately. Similar symptoms are observed in patients with platelet disorders, and recently, the pbq has been shown to be potentially useful for assessing bleeding severity in children with these disorders 19.
Assessing the need for a laboratory evaluation for bleeding disorders. Approach to a bleeding child pediatric oncall journal. The aim is to ensure that the intake of food and drink does not cause the ph of the oral cavity to. In children with severe bleeding disorders, the bleeding history is usually clear. Documenting a history of the response to haemostatic stress is useful in determining the likelihood of a significant bleeding disorder. Bleeding is a common symptom and does not always indicate an underlying bleeding disorder. There must be a logical systematic approach and a discriminate use of laboratory investigations to reach the diagnosis and assess severity. A practical approach to urine dipstick test abnormalities in.
Evaluation and management of abnormal uterine bleeding in. Identification and basic management of bleeding disorders in. Bleeding disorders is a general term for a wide range of medical problems that lead to poor blood clotting and continuous bleeding. Diagnosis of hemophilia and other bleeding disorders. Approach to a child with bleeding in the emergency room.
A practical approach to abnormalities in urine dipstick testing kidney and urinary tract disorders in a child may manifest in any of the following ways. Approach to the bleeding child pediatric clinics of north america. Occurs almost exclusively in males due to an xlinked pattern of inheritance. Diagnostic testing for specific platelet and coagulation factor disorders and overviews of the hemostatic process and the uses of specific coagulation tests are presented separately. Patients susceptibility to musculoskeletal hemorrhage can lead to recurrent hemarthroses and development of target joints. Heavy bleeding caused by problems with ovulation, endometriosis, polycystic ovary syndrome, and fibroids often can be managed with certain hormonal birth control methods. An approach to investigation of easy bruising archives of. For premenarchal bleeding, the parentguardian and child should be asked whether they have noticed any secondary sexual characteristics such as pubic and axillary hair or breast development.
Graded as mild, moderate, or severe, based on factor viii or ix level. Pediatric bleeding disorders a clinical casebook amy l. Laboratory testing should be used to confirm clinical suspicion and guide the management. Presented in a casebased format, each case presents a different variant of bleeding disorder, illus. Depending on the type, these methods can lighten menstrual flow, help make periods more regular, or even stop bleeding completely. If a pipette is inaccurate beyond the following limits mean weight, it must be taken out of use immediately. Approach to inborn errors of metabolism learn pediatrics. Child abuse or bleeding disorderan interdisciplinary approach ralf kno. To understand approach to a bleeding child, it is essential to know the steps in hemostasis. Approach to the pediatric patient with a bleeding disorder.
Clinical report evaluation for bleeding disorders in. The nature of the bleeding should be explored in addition to a family history and pedigree, and a careful examination with appropriate screening tests. Coagulation guidelines for unexplained bleeding disorders. The approach to a patient with a bleeding disorder. Chewing on hard andor sharp objects may cause gum bleeding. Excessive bleeding after tooth extractions or minor surgery for example, tonsillectomy is a characteristic of disorders of haemostasis, and its absence excludes significant abnormality. To address this, in 2010 the cdc and the national hemophilia foundation nhf engaged harris interactive to conduct a national webbased survey to assess the knowledge, attitudes, and health behaviors about the menstrual experiences of young women 18 through 25.
Coagulation guidelines for unexplained bleeding disorders washington state clinical laboratory advisory council originally published. Approach to the bleeding child handbook of pediatric. Symptoms such as gum bleeding, epistaxis, menorrhagia, petechiae, and bruising are especially common. Conversely, disseminated intravascular coagulation dic occurs in sick. Outline 2 introduction history taking physical finding investigation references 3. Management of bleeding disorders in children hematology. The inappropriate diagnosis of child abuse could occur,810 potentially resulting in the removal of a child from a home andor the potential. Also known as biochemical diseases, inherited metabolic disorders are mostly single gene disorders that affect one of the biochemical processes of the body. Nursing working group nurses guide to bleeding disorders page 4 of 16 once the child starts crawling and walking, the number of bleeding episodes may increase. Fundamentals for a systematic approach to mild and moderate. Child abuse or bleeding disorder an interdisciplinary approach. Department of pediatrics and communicable diseases, university of michigan, ann arbor, mich after completing this article, readers should be able to.
Most are rare but some are common, for example phenylketonuria pku occurs 1 in 12,000 births 1. Bleeding history usually clear in patients with severe bleeding disorders in patients with mildmoderate bleeding symptoms a standardized questionnaire is helpful standardized scores to quantitate bleeding symptoms. A lack of information about bleeding disorders is a serious public health concern. Thrombocytopenia and specific bleeding disorders, including. Note that in infants, consciousness can be defined operationally. An approach to the bleeding child fulltext sickkids handbook of. Having established the need for blood tests,a blood count and clotting screen see table 1 are essential baseline an approach to investigation of easy bruising 489.