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Topic: Bleeding diathesis

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	Bleeding Diathesis Diagnosed After Cleft Palate Repair (Site not responding. Last check: 2007-11-07)
		Bleeding diathesis is a clinical definition in which patients have uncontrolled bleeding problems for different reasons.
		In the newborn period, patients with bleeding diathesis present as CNS bleeding or uncontrolled bleeding from the umbilical stump.
		Bleeding reoccurred several times from different locations (from rough surface of the palate, from major palatine artery and finally from mucosal surface of the uvula).
	ispub.com /ostia/index.php?xmlFilePath=journals/ijs/vol3n2/bleeding.xml (1241 words)

	Gastrointestinal Bleeding (Site not responding. Last check: 2007-11-07)
		Confirming the presence of blood and assessing the severity of the bleeding are the priorities of the practitioner.
		Bleeding from esophageal varices is not common in the neonatal period but has been described in children with severe cytomegalovirus neonatal hepatitis.
		Vasculitis is responsible for edema of the bowel, rectal bleeding, intestinal obstruction, and perforation.
	www.naspghan.org /sub/Gastrointestinal_Bleeding.htm (4716 words)

	eMedicine - Factor XIII : Article Excerpt by: Rajalaxmi McKenna, MD, FACP
		The presence of a bleeding diathesis in families with an X-linked pattern of inheritance of the disorder has been recognized for hundreds of years.
		Knowledge of the fact that blood clots that are formed in the presence of calcium are stronger, insoluble in alkali, and resistant to proteolytic degradation led to the concept of insoluble clots in the earlier part of the last century.
		In 1948, Laki and Lorand recognized that a serum factor, termed fibrin stabilizing factor, was responsible for the characteristics of insoluble fibrin clots.
	www.emedicine.com /med/byname/factor-xiii.htm (620 words)

	USCneurosurgery Online Library "Operation for Head Trauma"evaluation
		Occult bleeding is from vessels that cannot be directly visualized because of their small calibre or location under a bone flap edge (or other visually obstructing structure).
		This bleeding is most often supposed to be and probably is subdural but epidural and subarachnoid bleeding into the operative field from under a bone flap are possible as well.
		Stopping occult bleeding from an unknown source is difficult because measures taken to stop bleeding from one layer or locating may provoke it at another.
	uscneurosurgery.com /infonet/ecrani/postop.htm (10653 words)

	Introduction: GI Bleeding: Merck Manual Professional
		Bleeding of any cause is more likely, and potentially more severe, in patients with chronic liver disease or hereditary coagulation disorders or in those who are taking certain drugs.
		Melena is fl, tarry stool and typically indicates upper GI bleeding, but bleeding from a source in the small bowel or right colon may also be the cause.
		However, orthostatic measurements are unwise in patients with severe bleeding (possibly causing syncope) and unreliable as a measure of intravascular volume in patients with mild bleeding, especially elderly patients.
	www.merck.com /mmpe/sec02/ch010/ch010a.html (1822 words)

	Xigris.com - Safety information
		Bleeding is the most common serious adverse effect associated with Xigris therapy.
		Bleeding is the most common adverse reaction associated with Xigris therapy.
		In the Phase 3 study, serious bleeding events were observed during the 28-day study period in 3.5% of Xigris-treated and 2.0% of placebo-treated patients.
	www.xigris.com /safety.jsp (693 words)

	Antech News - June 2005
		The most common diseases manifesting a bleeding tendency attributable to platelet dysfunction are renal failure and uremia and liver disease.
		The classic clinical case of uremic bleeding is tha of the old dog with compensated chronic interstitial nephritis which has inflamed gums and chronic periodontal disease.
		The bleeding diathesis is severe and of the purpuric type, and epistaxis is common and profuse.
	www.antechdiagnostics.com /clients/antechNews/2005/jun05_02.htm (401 words)

	UpToDate Approach to the child with a bleeding disorder
		For example, bleeding from the umbilical stump with delayed wound healing suggests the presence of factor XIII deficiency [1].
		The value of a detailed bleeding history was emphasized in a study in which routine pre-operative laboratory testing failed to detect any clinically significant abnormalities in patients with normal bleeding histories [2].
		— An inherited bleeding disorder should be strongly considered when the onset of bleeding manifestations occurs in infancy or early childhood and is associated with a positive family history.
	patients.uptodate.com /topic.asp?file=pedi_hem/8754 (606 words)

	Nosebleeds in Pediatrics (Site not responding. Last check: 2007-11-07)
		Children who are actively bleeding through the nose when seen should be positioned sitting upright and leaning forward slightly and they should be given a basin and tissue; direct pressure should be applied.
		If the bleeding continues after external compression, children should be instructed to blow their noses to remove as much clot as possible.
		Continued bleeding is slowed by cauterizing the four quadrants surrounding the bleeding point to interrupt flow from surrounding vessels.
	home.coqui.net /myrna/nose.htm (1721 words)

	Association of Clinical Scientists
		Lastly, he tells you that the patient was not on anticoagulants or aspirin prior to surgery, and has no history of a bleeding diathesis.
		As with this patient, initial management of post-bypass patients who are bleeding usually entails the administration of platelets to treat presumed platelet dysfunction.
		Three hours later you are contacted and are told that the patient had developed tamponade, gone into shock, is now bleeding rapidly without visible clots out of both chest tubes, and has received another four units of red cells over the past 45 minutes.
	www.clinicalscience.org /case5.html (1399 words)

	AVMI - Methimazole
		Clinical side effects developed in 48 (18.3%) of the 262 cats and included anorexia, vomiting, lethargy, self-induced excoriations of the face and neck, bleeding diathesis, and icterus associated with hepatopathy.
		The bleeding diathesis (epistaxis or oral bleeding) associated with thrombocytopenia in five cats resolved within 5 days after cessation of methimazole.
		In all of the cats in which bleeding developed, drug administration was stopped and none were rechallenged with methima-zole.
	www.avmi.net /NewFiles/Hyperthyroidism/methimazole.html (990 words)

	MUSC Digestive Disease Center - Hot Topics
		I believe that this is the best screening technique for a bleeding diathesis, and routine blood tests such as a prothrombin time, PTT, bleeding time, clotting time and platelets do not substitute for a good medical history.
		That night, if no bleeding occurs, warfarin is re-instituted and the patient remains in the hospital for a few days until the prothrombin time returns to therapeutic levels when heparin is discontinued and the patient is discharged.
		The bleeding problem in this subset of patients, those who require anticoagulation and those with a primary hematologic disorder, is that the bleeding rarely occurs at the time of polypectomy, but rather 7-10 days later, when the eschar sloughs and a normal patient may have a slight amount of bleeding.
	www.ddc.musc.edu /ddc_pro/pro_development/hot_topics/aspirin-waye.htm (694 words)

	Jejunal Gastrointestinal Stromal Tumor: A Cause of Obscure Gastrointestinal Bleeding Archives of Pathology & ...
		On average, 27% of patients with obscure GI bleeding have small intestinal lesions.2 Diagnosing these lesions is frequently difficult because they tend to be inaccessible to routine endoscopy.
		A repeat bleeding scan, angiogram, colonoscopy, and esophagogastroduodenoscopy with small bowel enteroscopy (to the proximal jejunum) were all unsuccessful in establishing an etiology.
		In as many as 5% of patients with obscure GI bleeding, a source cannot be identified despite extensive examination.5 When a lesion cannot be identified after standard upper endoscopy and colonoscopy, further evaluation depends on the briskness of bleeding (see algorithm).
	www.findarticles.com /p/articles/mi_qa3725/is_200402/ai_n9403024 (875 words)

	UpToDate Approach to the patient with a bleeding diathesis
		— Bleeding that is spontaneous, excessive, or delayed in onset following tissue injury results from a localized pathologic process or a disorder of the hemostatic process, involving a complex interplay among vascular integrity, platelet number and function, coagulation factors, and fibrinolysis.
		Given the variability in patients' perceptions of bleeding, as well as the lack of a uniform clinical measure of bleeding severity [3], a dialogue between the patient and physician is essential for the consideration of a bleeding diathesis.
		— Patients with a suspected bleeding disorder should be questioned about past bleeding problems, a history of iron-responsive anemia, bleeding outcomes following surgical procedures and tooth extractions, history of transfusion, character of menses, and dietary habits or antibiotic use which might predispose to vitamin K deficiency.
	patients.uptodate.com /topic.asp?file=coagulat/8369 (559 words)

	index (Site not responding. Last check: 2007-11-07)
		If bleeding cannot be controlled with pressure, infusion of INTEGRILIN and concomitant heparin should be stopped immediately.
		Bleeding is the most common complication encountered during INTEGRILIN therapy.
		In the registration trials, the majority of excess major bleeding events were localized at the femoral artery access site.
	www.integrilin.com /index2.html (353 words)

	eMedicine - Dengue Fever : Article Excerpt by: Daniel D Price, MD (Site not responding. Last check: 2007-11-07)
		In a small proportion of cases, the virus causes increased vascular permeability that leads to a bleeding diathesis or disseminated intravascular coagulation (DIC) known as dengue hemorrhagic fever (DHF).
		Increased vascular permeability, bleeding, and possible DIC may be mediated by circulating dengue antigen-antibody complexes, activation of complement, and release of vasoactive amines.
		In the process of immune elimination of infected cells, proteases and lymphokines may be released and activate complement coagulation cascades and vascular permeability factors.
	www.emedicine.com /emerg/byname/dengue-fever.htm (556 words)

	Hermansky-Pudlak Syndrome
		Hermansky-Pudlak syndrome (HPS) is a multi-system disorder characterized by tyrosinase positive oculocutaneous albinism, a bleeding diathesis resulting from a platelet storage pool deficiency, and, in some cases, pulmonary fibrosis or granulomatous colitis.
		The bleeding diathesis of HPS can result in variable bruising, epistaxis, gingival bleeding, postpartum hemorrhage, colonic bleeding, and prolonged bleeding during menstruation or after tooth extraction, circumcision, or other surgeries.
		The colitis is severe in 15% of cases and occasionally requires colectomy; affected individuals may have the inflammatory bowel disease of HPS without the explicit diagnosis of colitis.
	www.geneclinics.org /profiles/hps/details.html (4311 words)

	Cecil Textbook of Medicine : />
		In a patient with a history of excessive or unexplained bleeding, the initial problem is to determine whether the cause is a systemic coagulopathy or an anatomic or mechanical problem.
		Patterns of clinical bleeding, as revealed by the history and physical examination, may be characteristic of certain types of coagulopathy (Table 162-1).
		In general, patients with thrombocytopenia or qualitative platelet and vascular disorders present with bleeding from superficial sites in the skin and mucous membranes; these may involve petechiae, which are pinpoint cutaneous hemorrhages that appear particularly over dependent extremities (characteristic of severe thrombocytopenia), ecchymoses (common bruises), purpura, gastrointestinal and genitourinary tract bleeding, epistaxis, and hemoptysis.
	www.merckmedicus.com /ppdocs/us/common/cecils/chapters/162_004.htm (1121 words)

	Clinical Trial: Study of Chediak-Higashi Syndrome
		Patients one month or older with decreased pigmentation and either a bleeding abnormality or history of excessive childhood infections may be eligible for this study, which is expected to continue for 5 to 10 years.
		Chediak-Higashi syndrome (CHS) is a rare autosomal recessive disorder characterized by oculocutaneous albinism, a bleeding diathesis, recurrent infection due to abnormal neutrophil and natural killer cell function, and eventual progression to a lymphohistiocytic infiltration known as the "accelerated phase".
		Death often occurs within the first decade as a result of bleeding, infection, or development of the accelerated phase; bone marrow transplantation is curative except for the late occurrence of neurological deterioration.
	www.clinicaltrials.gov /ct/gui/show/NCT00005917 (788 words)

	Bioline International Official Site (site up-dated regularly)
		In the present case report, anaesthetic management for splenectomy during pregnancy complicated with pregnancy induced hypertension and bleeding diathesis secondary to ITP is described with reference to above risks.
		Immunoglobulin therapy has prominent role in rapid restoration of the platelet count during bleeding diathesis, as splenectomy sparing measure and for preoperative preparation to caesarean section, splenectomy or other surgeries during pregnancy.
		The frequency of non-obstetric surgeries during pregnancy is low, approximately 2 per 1000 cases.(4) Haemorrhagic diathesis due to ITP unresponsive to medical management presents considerable risk to mother as well as foetal well-being and requires immediate surgical intervention.
	www.bioline.org.br /request?jp01056 (1299 words)

	New Page 3
		Thus, it should be reserved for situations in which acute variceal bleeding is not controlled by pharmaceutical treatment, endoscopic sclerotherapy, or endoscopic variceal ligation and in which contraindications for surgical management are present.
		Because of the frequency and severity of recurrent variceal bleeding, effective preventive treatment is mandatory in patients surviving an episode of acute variceal bleeding.
		Complications associated with GI bleeding - Vascular collapse; the sequelae of hypotension, cardiomyopathy, arrhythmias, aspiration pneumonia, sepsis, spontaneous bacterial peritonitis, overtransfusion, and rebound rebleeding of varices; and encephalopathy
	www.gimed.info /varices2005.htm (3482 words)

	Postgraduate Medicine: Manifestations of hemoptysis
		The amount of blood expectorated is important because the rate of bleeding is a major determinant of morbidity.
		Tuberculosis is a leading cause of hemoptysis in developing countries and should be a differential diagnostic consideration in patients who are immigrants from countries with a high prevalence of this disease.
		Localization of the bleeding site to the level of the bleeding lung or lobe is necessary for proper medical or surgical management.
	www.postgradmed.com /issues/2002/10_02/johnson.htm (2880 words)

	womens health pms menopause - uterine bleeding urinary bleeding.
		Dysfunctional uterine bleeding (DUB) is the most common cause of abnormal vaginal bleeding during a woman's reproductive years.
		Occasionally, bleeding is profuse with associated signs and symptoms of hypovolemia, including hypotension, tachycardia, diaphoresis, and pallor.
		An adverse effect of this drug is prolonged uterine breakthrough bleeding; this may continue after discontinuation of the drug because of persistent anovulation.
	www.womens-health-pms-menopause.com /uterine_bleeding.html (1128 words)

	BioMed Central \| Full text \| Hemoptysis, a developing world perspective
		In cases with lateralized or localized persistent bleeding immediate, albeit transient, control of the airway may be obtained with topical therapy, endobronchial tamponade, or unilateral intubation of the nonbleeding lung.
		Angioembolization of the pathologic bleeding bronchial arterial vessels is now globally recommended as the treatment of choice in most cases [3,5].
		Even as principal focus in critical presentation is directed towards identification and stoppage of the source of bleeding, it is the primary etiology that dictates the clinical course and treatment strategy [9,10].
	www.biomedcentral.com /1471-2466/6/1 (1961 words)

	APL definition - Cancer information on MedicineNet.com
		There is usually pancytopenia with low levels of red blood cells (anemia), low levels of the granulocytes and monocytes (types of white blood cells that fight infections), and low levels of platelets (that are needed for blood to clot normally).
		The bleeding can manifest itself as petechiae (little bleeding spots in the skin or elsewhere), small ecchymosis (bruises), epistaxis (nose bleeds), bleeding in the mouth, hematuria (blood in the urine), bleeding from venipuncture and bone marrow sites and in girls and women who are menstruating may have menometrorrhagia (excessive irregular menstrual bleeding).
		The hemorrhagic diathesis (bleeding condition) may precede the diagnosis of leukemia by 2-8 weeks.
	www.medterms.com /script/main/art.asp?articlekey=19757 (714 words)

	GIbleedupper
		Mallory-Weiss tear, ii) the true source of the bleeding was from an epistaxis or hemoptysis, iii) the bleeding lesion is technically difficult to see eg.
		Dieulafoy's lesion, iv) the bleeding is distal to the proximal duodenum and inaccesible to upper endoscopy, or v) the story/evidence of upper GI bleeding was fabricated eg.
		GI bleeding that is associated with a co-existing condition that may warrant surgery eg.
	www.jeffmann.net /NeuroGuidemaps/gibleedupper.html (3226 words)

	Abstract
		A 45 year-old woman developed bleeding diathesis caused by high-titre inhibitor and died.
		Factor replacement is recommended to prevent further bleeding episodes and to maintain the reproductive capacity in women.
		The possibility of development of a specific inhibitor must be considered because the bleeding diathesis in these patients is difficult to treat.
	www.blackwellpublishing.com /isth2005/abstract.asp?id=47652 (346 words)

	Why Do Greyhounds Bleed? \| OSU College of Veterinary Medicine
		Twenty veterinarians returned the survey, and the consensus opinion is that 10 to 15% of Greyhounds bleed profusely (frequently requiring a blood transfusion as a life-saving measure) 1 to 4 days after simple surgical procedures such as spays, neuters, dewclaw removals, or laparotomies.
		A retrospective evaluation of the medical records of the last 10 Greyhounds who had a limb amputated for primary bone tumors at OSU revealed that most of them had severe postoperative bleeding (9/10); the bleeding was diffuse, in the ventral abdomen and distal limbs, and frequently required transfusion of blood components.
		The buccal mucosa bleeding time has been used historically to screen for VWD in dogs; however, this test has marked inter- and intraobserver variability, and is not highly reliable on the clinical setting.
	www.vet.ohio-state.edu /2097.htm (1522 words)

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