Hemorrhagic syndrome , or a tendency to cutaneous hemorrhage and bleeding of the mucous membranes, occurs as a result of changes in one or more of the links of hemostasis . This may be a lesion of the vascular wall, a violation of the structure, function and number of platelets , a violation of coagulation hemostasis. When determining the causes of bleeding, it is necessary to take into account that some types of pathology are frequent, others are rare, and still others are extremely rare. Of the hereditary disorders of hemostasis, thrombocytopathy , hemophilia A , von Willebrand disease , hemophilia B occur most frequently in therapeutic practice, and telangiectasia is of vascular forms. The cause of the acquired forms of hemorrhagic syndrome most often are secondary thrombocytopenia and thrombocytopathy, DIC , deficiency of prothrombin complex factors and hemorrhagic vasculitis . Other forms are rare or very rare. It should be borne in mind that in recent years hemostasis disorders and, as a result, hemorrhagic syndrome are increasingly associated with taking medications that violate platelet aggregation ( antiplatelet agents ) and blood clotting ( anticoagulants ), as well as psychogenic forms - neurotic bleeding and Munchausen syndrome .
Clinical characteristics
There are 5 types of hemorrhagic syndrome.
- Hematomatous. There is a deficiency of VIII, IX, XI coagulation factors. Typical for hemophilia A and B, characterized by the occurrence of painful intense hemorrhages in the soft tissues and joints, the gradual development of disorders of the musculoskeletal system. Characteristically later bleeding after several hours after injury.
- Petechial spotted (Sinyachkov). There is a deficiency of II, V, X coagulation factors. Occurs with thrombocytopenia, thrombocytopathy, coagulation disorders (hypo- and dysfibrinogenemia, hereditary deficiency of coagulation factors).
- Mixed (microcirculatory-hematogenous). It develops with severe deficiency of prothrombin complex factors and factor XIII, von Willebrand disease, DIC, overdose of anticoagulants and thrombolytics, the appearance of immune inhibitors of factors VIII and IX in the blood and is characterized by a combination of petechially-patchy skin hemorrhages with individual large hematomas in the retroperitoneal space of the intestine . Unlike hematoma type, hemorrhage into the joint cavity is extremely rare. Bruises can be extensive and painful. As well as a deficiency of 7 coagulation factors.
- Vasculito-purple type. It is observed in infectious and immune vasculitis, it is easily transformed into DIC and is characterized by hemorrhage in the form of a rash or erythema on an inflammatory basis, the possible addition of nephritis and intestinal bleeding.
- Angiomatous type. It develops in the areas of telangiectasia , angiomas , arteriovenous shunts and is characterized by persistent local hemorrhages associated with areas of vascular pathology.
With a certain probability, the pathology of the vascular-platelet or coagulation link of hemostasis can be suggested by the peculiarities of hemorrhagic manifestations.
Signs of violations of vascular platelet and coagulation hemostasis
| Clinical sign | Coagulation changes hemostasis | Changes in vascular platelet hemostasis |
|---|---|---|
| Petechiae | Are rare | Are characteristic |
| Dissecting hematomas | Are characteristic | Are rare |
| Superficial ecchymosis | Often large single | Usually small multiple |
| Hemarthrosis | Are characteristic | Are rare |
| Delayed bleeding | Is common | Rare |
| Bleeding from cuts and scratches | Minimum | Long, often intense |
| Gender of Patients | 80-90% for men | Somewhat more often in women |
| Indication of family history | Often | Rarely |
The initial stage of the differential diagnosis of hemorrhagic syndrome is always the counting of peripheral blood platelets and the simplest coagulation tests.
Literature
- "Guide to internal medicine for the general practitioner" ed. F.I. Komarov, 2007, ISBN 5-89481-367-0
Links and Sources
- Hemorrhagic syndrome in children (not available link)