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Coagulation

Bleeding disorders

Bleeding disorders - general

Reviewer: Jeremy Parsons, M.D. (see Reviewers page)
Revised: 20 June 2012, last major update June 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

General
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● Bleeding disorders are often classified as defects of primary hemostasis (platelets, vessels, etc.) or of secondary hemostasis (coagulation cascade and its regulation)

Clinical history is important:
(a) single site (suggests structural lesion) vs. multiple sites (coagulopathy)
(b) for coagulopathies: hereditary (family history of bleeding or bleeding since childhood) vs. acquired (no previous bleeding history)
(c) time from “hemostasis challenge” to bleeding symptoms: immediate suggests platelet/primary hemostasis disorder (inability to form normal platelet plug) versus late suggests coagulopathy/secondary hemostasis (breakthrough bleeding occurs after platelet plug due to impaired fibrin formation); even further delay suggests a Factor XIII deficiency (fibrin clot forms to stop bleeding but is unstable and breaks down due to lack for crosslink stabilization)
(d) physical exam: petechiae (primary hemoastasis/platelet disorders) vs. hematoma or hemarthrosis (secondary hemostasis/coagulation defects) vs. mucous membrane bleeding or bruising (nonspecific, often primary hemostasis)

Gross images
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Petechiae


Hematoma

End of Coagulation > Bleeding disorders > Bleeding disorders - general

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