Aswathi Haridas

3rd year
 Classification of bleeding disorder

 Classification of clotting disorder

 Laboratory investigations
 BLEEDING DISORDERS

• Vessel wall disorders

• Platelet disorders
• Coagulation disorders
 Scurvy
Vitamin C deficiency (below 10 mg/day)

 Cushing’s syndrome
Excessive exogeneous or endogeneous
corticosteroid intake or production.

 Ehlers-Danlossyndrome
Autosomal dominant disorder of connective
tissue matrix.
 Results in fragile skin vessels and easy bruising.

Rendu-Osler-Weber syndrome
Abnormal telangiectatic capillaries.
Autosomal dominant disorder
 Acquired
 Congenital
 Thrombocytopenias occur when platelet quantity is
reduced.
Caused by
Decreased production in bone marrow
Increased sequestration in the spleen
Accelerated destruction
 Thrombocytopathies result from defects in any of
the critical platelet reactions.
 Congenital:
Hemophilia A
Hemophilia B
Factor XI deficiency
Factor XII deficiency
Factor X deficiency
Factor V deficiency
Factor XIII & I deficiency
von Willebrand disease
Anti coagulant related coagulopathies:
Heparin
Coumarin

Disease related coagulopathies:

Liver disease
Vitamin K deficiency
Disseminated intravascular coagulation
Fibrinolytic disorders
 FORBLEEDING DISORDER:
 Bleeding time
 Tourniquet test
 Platelet count
 FOR CLOTTING DISORDER:
 Factor V assay
 Fibrinogen level
 Prothrombin time
 Platelet count
 Thrombin time
 International Normalized Ratio
 Activated partial thromboplastin time
 Platelet count:
Normal 1,50,000-4,50,000/mm3.
Spontaneous clinical hemorrhage not
observed with platelet count above 10,000 to 20,000/mm3
Surgical or traumatic hemorrrhage is more
likely if count is below 50,000/mm3.

 Bleeding time:
To identify qualitative or functional platelet
defects
1-6 minutes-Normal
Prolonged >15 minutes
Prothrombin time:
Normal 11-13 seconds
Evaluate extrinsic coagulation factor I, II,
V, VII and X.

 aPTT (activated partial thromboplastin time):

Normal 15-35 seconds
Used to evaluate the intrinsic cascade and
measure the functional levels of factors VIII, IX, XI and
XII.
 Thrombin time:
Normal 9-13 seconds
Tests ability to form initial fibrin clot from
fibrinogen, by adding thrombin to plasma.
Also, used to measure presence of heparin
that inhibit conversion of fibrinogen to fibrin.

 Fibrin degradation products:

Measured using a specific latex agglutination
system.
Evaluates presence of the D-dimer of
fibrinogens.
 Factor assay:
Identify factor deficiencies and their
level of severity, specific activity levels of factor can be
measured.
It is done to assess the vWD(types I-III
and platelet type)
 Tourniquet test:
For capillary fragility.
Assess the Rumpel-Leede phenomenon.
Useful for identifying disorders of vascular wall
integrity or platelet disorders.
 Stasis is produced by inflating a
sphygmomanometer cuff around the arm in the usual
manner to a pressure halfway between systolic and diastolic
levels.
This moderate degree of stasis is maintained for 5
minutes.
At 2 minutes following cuff deflation and removal, a
2.5 cm diameter region of skin on the volar surface of the
arm at 4 cm distal to antecubital fossa.
International Normalized Ratio:
Ratio of prothrombin time that adjusts for
the sensitivity of the thromboplastin reagent, such that a
normal coagulation profile is reported as an INR of 1.0
Evaluates the extrinsic coagulation
system and measures absence or presence of clotting
factors I, II, V, VII and X.
Measure the effects of coumarin
anticoagulants and reduction of vitamin-K dependent
factors II, VII, IX and X.
INR= Patient prothrombin time
Mean normal prothrombin time
Bleeding disorder Platelet Prothrombin Activated Bleeding
count time partial time (BT)
thromboplastin
time
Severe liver
disease
DIC

F XIII N N N N
Deficiency

Vascular wall N N N
defect
Bleeding Platelet Prothrombin Activated partial Bleeding
disorders count time thromboplastin time
time

Heparin N N N
anticoagulation
Factor VIII, IX,
XI deficiencies

Vitamin K N N
deficiency
Intestinal
malabsorbtion
Factor II, V, X
deficiencies

Coumarin N N N
anticoagulation
Liver disease
Factor VII
Bleeding Platelet Prothrombin Activated partial Bleeding
disorders count time thromboplastin time
time

von N, N N,
Willebrands
disease

Rivaroxaban N N
anticoagulation

Disseminated
intravascular
coagulation
 Burket’s
Oral Medicine Diagnosis and
Treatment 10th edition.