Bleeding Disorders

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 31 December 2017

⏱️ 8 minutes

🔗️ Recording | iTunes | RSS

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Summary

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)

Transcript

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0:00.0	Hello, med students. My name is Zach Olson, and thank you for downloading this special holiday episode of the EM Clerkship Podcast.
0:10.0	I hope you enjoyed my song last week. This week, we're doing another special holiday topic about Christmas disease.
0:17.7	Hemophilia B, factor nine deficiency, it's called.
0:27.4	Tintanalyas puts this in the chapter with the other big three bleeding disorders, factor eight deficiency, and von Willa Brain's disease.
0:29.9	Those are the big three bleeding disorders.
0:32.5	These aren't really that high yield except in trauma or active bleeding where it becomes
0:36.2	really, really important.
0:38.1	We won't be covering thrombocytopenia in this episode at all, but you remember that with
0:43.4	those platelet disorders, thrombocitopinia with the low platelets and von Willabrand's disease
0:49.8	when those platelets can't bind because the Von Willa brand factor is low.
0:55.3	You see lots of skin and mucosal bleeding when that initial early platelet plug takes too
1:02.5	long or can't form.
1:04.1	You get mucosal GI bleeding.
1:06.5	We mentioned in the vaginal bleeding episode that it can cause vaginal bleeding.
1:12.0	It can cause recurrent epistaxis, gingival bleeding, easy superficial skin bruising. When you see that type of stuff,
1:18.6	that's the platelets gone bad. On the flip side, delayed or deep bleeding, like into the joints
1:26.5	or into the brain or deep into the muscle,
1:29.5	that's more typical of those factor 8 and factor 9 hemophilias.
1:35.2	And remember that our objective today has nothing to do with diagnosing these.
1:40.1	You don't newly diagnose this in the ED unless you get like really lucky.
1:44.9	What you do need to know is how to fix these when a patient is bleeding and you find out on
1:51.5	history that they have one of these bleeding disorders.
	...

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