BLEEDING AND CLOTTING

Causes of abnormal bleeding:

• Vessel problems (rarely cause bleeding; often cause palpable purpura)
  • Vasculitides, e.g. HSP and Scurvy
  • Amyloid
• Platelet problems
  • Quantitative, too few-see above
  • Quantitative, too many-dx'd with "platelet aggregation test" (?)
  • Qualitative; evaluate with bleeding time (see above)
  • Thrombysthenia (no fibrinogen receptor?)
  • Drug induced (NSAIDs, EtOH)
• Coagulation Disorders

Treatment of abnormal bleeding:

• Recombinant activated coagulation factor VII (Novoseven)
  • Originally developed for treatment of bleeding in pts with hemophilia
  • Can also stop uncontrollable bleeding in pts w/o hemophilia
  • Reports exist of venous thrombosis, disseminated intravascular coagulation, and MI in pts treated with it