TAILIEUCHUNG - Chapter 059. Bleeding and Thrombosis (Part 5)

Epistaxis is a common symptom, particularly in children and in dry climates, and may not reflect an underlying bleeding disorder. However, it is the most common symptom in hereditary hemorrhagic telangiectasia and in boys with vWD. Clues that epistaxis is a symptom of an underlying bleeding disorder include lack of seasonal variation and bleeding that requires medical evaluation or treatment, including cauterization. Bleeding with eruption of primary teeth is seen in children with more severe bleeding disorders, such as moderate and severe hemophilia. It is uncommon in children with mild bleeding disorders. Patients with disorders of primary hemostasis (platelet. | Chapter 059. Bleeding and Thrombosis Part 5 Epistaxis is a common symptom particularly in children and in dry climates and may not reflect an underlying bleeding disorder. However it is the most common symptom in hereditary hemorrhagic telangiectasia and in boys with vWD. Clues that epistaxis is a symptom of an underlying bleeding disorder include lack of seasonal variation and bleeding that requires medical evaluation or treatment including cauterization. Bleeding with eruption of primary teeth is seen in children with more severe bleeding disorders such as moderate and severe hemophilia. It is uncommon in children with mild bleeding disorders. Patients with disorders of primary hemostasis platelet adhesion do have increased bleeding after dental cleanings and other procedures that involve gum manipulation. Menorrhagia is defined quantitatively as a loss of 80 cc of blood per cycle based on blood loss required to produce iron-deficiency anemia. A complaint of heavy menses is subjective and has a poor correlation with excessive blood loss. Predictors of menorrhagia include bleeding resulting in iron-deficiency anemia or a need for blood transfusion excessive pad or tampon use menses lasting longer than 8 days passage of clots bleeding through protection or flooding at night. Menorrhagia is a common symptom in women with underlying bleeding disorders and is reported in the majority of women with vWD and factor XI deficiency and in symptomatic carriers of hemophilia A. Women with underlying bleeding disorders are more likely to have other bleeding symptoms including bleeding after dental extractions postoperative bleeding and postpartum bleeding and are much more likely to have menorrhagia beginning at menarche than women with menorrhagia due to other causes. Postpartum hemorrhage is a common symptom in women with underlying bleeding disorders. This occurs most commonly in the first 48 h after delivery but it may also be manifest by prolonged or excessive bleeding .

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