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Evaluation and Approach to Management of a Bleeding Child

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Dr Raj Warier, Louisiana    16 January 2018

  1. It is important to understand the pathophysiology of coagulation.
  2. For the correct diagnosis, accurate history of the patient should be taken; simple initial laboratory tests should be followed up with specific laboratory tests.
  3. Fragmented red cells (schistocytes) are seen in microangiopathies (e.g., TTP, HUS, DIC), and cardiovascular disorders. Serial counting in TTP may correlate with change in serum LDH levels. Normal reference range of schistocyte count is 0.03-0.58%.
  4. Central nervous system bleeds – These are the most common cause of fatal bleeding. They may occur in a delayed fashion. We must treat even minor head trauma in general. When in doubt, or if there is any sign of objective head trauma, we must treat.
  5. Treatment of bleeding is based on diagnosis – avoid FFP, steroids, etc. without diagnosis except in emergency cases.
  6. Comprehensive care should be provided.
  7. Bleeding vs. thrombosis:
BleedingThrombosis
Decreased procoagulant factorsIncreased procoagulant factors; decreased natural anticoagulants
ThrombocytopeniaThrombocytosis
Vessel wall damageVasculitis
Increased fibrinolytic potentialDecreased fibrinolytic potential

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