Key facts and checkpoints

• Purpura = petechiae + ecchymoses.

• Abnormal bleeding is basically the result of disorders of (1) the platelet, (2) the coagulation mechanism, or (3) the blood vessel.

• There is no substitute for a good history in the assessment of patients with bleeding disorders.

• An assessment of the personal and family histories is the first step in the identification of a bleeding disorder.

• When a patient complains of 'bruising easily' it is important to exclude thrombocytopenia due to bone marrow disease and clotting factor deficiencies such as haemophilia.

• The commonest cause of an acquired bleeding disorder is drug therapy, e.g. aspirin, NSAIDs, cytotoxics and oral anticoagulants.

• In general, bleeding secondary to platelet defects is spontaneous, associated with a petechial rash and occurs immediately after trauma or a cut wound. 1

• Laboratory assessment should be guided by the clinical impression.

• Bleeding caused by coagulation factor deficiency is usually traumatic and delayed, e.g. haemorrhage occurring 24 hours after a dental extraction in a haemophiliac.

• The routine screening tests for the investigation of patients with bleeding disorders can be normal despite the presence of a severe haemorrhagic state.

petechias ecchymosig purpura

Fig. 35.1 Purpuric rash (petechiae and ecchymoses)

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