Bleeding Disorders

These are most important in trauma patients!!! Platelet Disorders * Symptoms of SUPERFICIAL bleeding* Mucosal bleeding* GI bleeding* Recurrent epistaxis* Thrombocytopenia* When the platelets ARE LOW* Refer to THIS episode* Von-Willebrand disease* When the platelets CAN’T BIND* Treatment * Desmopressin (DDAVP)* Causes increase in amount of von-willebrand factor (vWF) available* Also causes free water retention* Treatment of diabetes insipidus* Replace vWF* Transfuse factor VIII* Contains vWF (factor VIII binds vWF)* Transfuse cryoprecipitate The Hemophilias * Symptoms of DEEP bleeding* Hemarthrosis* Hematomas* Intracranial Bleeding* Factor IX deficiency (Christmas disease)* Treat by replacing factor IX* Rate the “severity” of the bleeding on a scale of 1-100* Dosing equals the severity score in milligrams* For example* 25 = 25mg/kg factor = mild bleeding (mild hematuria with stable hemoglobin, painful but contained hemarthrosis)* 50 = 50mg/kg factor = moderate bleeding = (rapid nose bleeds, rapid bleeding that won’t resolve)* 75 = 75mg/kg factor = severe bleeding = (GI bleeds with dropping hemoglobin, retroperitoneal hematoma)* 100 = 100mg/kg factor = deadly bleeding = (intracranial hemorrhage)* Factor VIII deficiency (Hemophilia A)* Treat by replacing factor VIII* Dosing similar to factor IX but you take severity score and divide by 2* For example* 25 = 12mg/kg factor = mild bleeding (mild hematuria with stable hemoglobin, painful but contained hemarthrosis)* 50 = 25mg/kg factor = moderate bleeding = (rapid nose bleeds, rapid bleeding that won’t resolve)* 75 = 37mg/kg factor = severe bleeding = (GI bleeds with dropping hemoglobin, retroperitoneal hematoma)* 100 = 50mg/kg factor = deadly bleeding = (intracranial hemorrhage) Additional Reading * Approach to Thrombocytopenia (EM Clerkship)* Treatment of Hemophilia (Hemophilia.org)