Editing Bleeding diathesis

{{Short description|High tendency to bleed due to a blood clotting disorder}}
{{Infobox medical condition (new)
| name            = Bleeding diathesis
| synonyms        = '''Haemorrhagic diathesis''', '''Hemorrhagic diathesis'''
| image           = Bleeding finger.jpg
| caption         = A [[bleeding]] wound in the finger
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In [[medicine]] ([[hematology]]), '''bleeding diathesis'''  is an unusual susceptibility to bleed ([[hemorrhage]]) mostly due to '''hypocoagulability''' (a condition of irregular and slow blood clotting), in turn caused by a [[coagulopathy]] (a defect in the system of [[coagulation]]). Therefore, this may result in the reduction of [[platelet]]s being produced and leads to excessive bleeding.<ref>{{Cite news|url=https://www.doctorshealthpress.com/general-health-articles/bleeding-diathesis/|title=Bleeding Diathesis: Causes, Symptoms, and Treatments|date=2017-06-23|work=Doctors Health Press - Daily Free Health Articles and Natural Health Advice|access-date=2018-09-17|language=en-US}}</ref> Several types of coagulopathy are distinguished, ranging from mild to lethal. Coagulopathy can be caused by thinning of the skin ([[Cushing's syndrome]]), such that the skin is weakened and is bruised easily and frequently without any trauma or injury to the body.<ref>{{cite journal |last= Douglas |first= Hubble | name-list-style = vanc |title=Cushing' Syndrome and Thymic Carcinoma |journal=QJM: An International Journal of Medicine |date=April 1949 |volume=18 |issue=2 | pages = 133–147 |doi=10.1093/oxfordjournals.qjmed.a066529 }}</ref> Also, coagulopathy can be contributed by impaired [[wound healing]] or impaired clot formation.<ref>{{cite book | vauthors = Amin C, Sharathkumar A, Griest A | title = Neurologic Aspects of Systemic Disease Part II | chapter = Bleeding diathesis and hemophilias | series = Handbook of Clinical Neurology | volume = 120 | pages = 1045–59 | date = 2014-01-01 | pmid = 24365370 | doi = 10.1016/B978-0-7020-4087-0.00070-X | isbn = 9780702040870 }}</ref>

==Signs and symptoms==

{|class="wikitable"
! Symptom !! Disorders
|-
|[[Petechiae]] (red spots)
|
* [[Wiskott–Aldrich syndrome]], where they may resemble a few bruises<ref name=was>[http://www.primaryimmune.org/publications/book_pats/e_ch07.pdf Wiskott–Aldrich Syndrome] {{Webarchive|url=https://web.archive.org/web/20101221144403/http://primaryimmune.org/publications/book_pats/e_ch07.pdf |date=2010-12-21 }} The International Patient Organisation for Primary Immunodeficiencies (IPOPI).</ref>
* [[Acute leukemia]]<ref name=bick>[https://books.google.com/books?id=d2bQQr3A-iMC Disorders of thrombosis and hemostasis: clinical and laboratory practice. Page ] Rodger L. Bick. Edition 3, illustrated. {{ISBN|0-397-51690-8}}, {{ISBN|978-0-397-51690-2}}. 446 pages</ref>
* [[Chronic leukemia]]<ref name=bick/>
* [[Vitamin K deficiency]]<ref name=emedicine>[http://emedicine.medscape.com/article/126354-overview Vitamin K Deficiency] eMedicine. Author: Pankaj Patel, MD. Coauthor(s): Mageda Mikhail, MD, Assistant Professor. Updated: Dec 18, 2008</ref>
|-
| [[Purpura]] and [[ecchymoses]]
|
* Acute leukemia<ref name=bick/>
* Chronic leukemia<ref name=bick/>
* Vitamin K deficiency<ref name=emedicine/>
|-
| [[Blood in stool]]
|
* [[Wiskott–Aldrich syndrome]], especially in infancy<ref name=was/>
* Acute leukemia<ref name=bick/>
|-
| Bleeding [[gingiva]] (gums)
|
* Wiskott–Aldrich syndrome<ref name=was/>
* Acute leukemia<ref name=bick/>
* Chronic leukemia<ref name=bick/>
|-
| Prolonged [[nose bleed]]s
|
* Wiskott–Aldrich syndrome<ref name=was/>
|}

===Complications===
Following are some complications of coagulopathies, some of them caused by their treatments:

{|class="wikitable"
! Complication !! Disorders
|-
| '''Soft tissue bleeding''', e.g. deep-muscle bleeding, leading to swelling, numbness or pain of a limb.
|
* [[Hemophilia]]<ref name=mayo-hemophilia>[http://www.mayoclinic.com/health/hemophilia/DS00218/DSECTION=complications Hemophilia Complications] By Mayo Clinic staff. May 16, 2009</ref>
* [[Von Willebrand disease]]<ref name=mayo-vwd/>
|-
| '''Joint damage''', potentially with severe pain and even destruction of the joint and development of [[arthritis]]
|
* Hemophilia<ref name=mayo-hemophilia/>
* [[Von Willebrand disease]]<ref name=mayo-vwd/>
|-
| '''[[Retinal bleeding]]'''
|
* Acute leukemia<ref name=bick/>
|-
| '''[[Transfusion transmitted infection]]''', from blood transfusions that are given as treatment.
|
* Hemophilia<ref name=mayo-hemophilia/>
|-
| '''Adverse reactions''' to clotting factor treatment.
|
* Hemophilia<ref name=mayo-hemophilia/>
|-
| '''[[Anemia]]'''
|
* [[Von Willebrand disease]]<ref name=mayo-vwd>[http://www.mayoclinic.com/health/von-willebrand-disease/DS00903/DSECTION=complications Von Willebrand disease --> Complications] By Mayo Clinic staff. Feb. 7, 2009</ref>
|-
| '''[[Exsanguination]]''' (bleeding to death)
|
* [[Von Willebrand disease]]<ref name=mayo-vwd/>
* Acute leukemia<ref name=bick/>
* Vitamin K deficiency<ref name=emedicine/>
|-
| [[Cerebral hemorrhage]]
|
* [[Wiskott–Aldrich syndrome]]<ref name=was/>
|}

==Causes==
While there are several possible causes, they generally result in excessive bleeding and a lack of clotting.{{citation needed|date=April 2022}}

=== Acquired ===
Acquired causes of coagulopathy include [[anticoagulation]] with [[warfarin]], [[liver failure]], [[vitamin K deficiency]] and [[disseminated intravascular coagulation]]. Additionally, the [[hemotoxic]] venom from certain species of [[snake]]s can cause this condition, for example [[Bothrops]], [[rattlesnake]]s and other [[species]] of [[Viperidae|viper]]. [[Viral hemorrhagic fever]]s include [[dengue hemorrhagic fever]] and dengue shock syndrome.
[[Leukemia]] may also cause coagulopathy. Furthermore, cystic fibrosis has been known to cause bleeding diathesis, especially in undiagnosed infants, due to malabsorption of fat soluble vitamins like vitamin K.{{citation needed|date=July 2020}}

=== Autoimmune causes of acquired coagulation disorders ===
There are autoimmune causes of coagulation disorders. They include acquired antibodies to coagulation factors, termed inhibitors of coagulation. The main inhibitor is directed against clotting factor VIII. Another example is [[antiphospholipid syndrome]], an autoimmune, hypercoagulable state.{{citation needed|date=July 2020}}

===Causes other than coagulation===
Bleeding diathesis may also be caused by impaired [[wound healing]] (as in [[scurvy]]), or by thinning of the skin, such as in [[Cushing's syndrome]].{{citation needed|date=November 2021}}

==Genetic==
Some people lack [[gene]]s that typically produce the [[protein]] coagulation factors that allow normal clotting. Various types of [[hemophilia]] and [[von Willebrand disease]] are the major genetic disorders associated with coagulopathy. Rare examples are [[Bernard–Soulier syndrome]], [[Wiskott–Aldrich syndrome]] and [[Glanzmann's thrombasthenia]]. Gene therapy treatments may be a solution as they involve in the insertion of normal genes to replace defective genes causing for the genetic disorder. Gene therapy is a source of active research that hold promise for the future.<ref>{{cite journal | vauthors = McCain J | title = The future of gene therapy | journal = Biotechnology Healthcare | volume = 2 | issue = 3 | pages = 52–60 | date = June 2005 | pmid = 23393464 | pmc = 3564347 }}</ref> <!-- Additional information -->

==Diagnosis==

===Comparing coagulation tests===
{| class="wikitable sortable"
|+ Laboratory findings in various platelet and coagulation disorders
! Condition  
! [[Prothrombin time]]
! [[Partial thromboplastin time]]
! [[Bleeding time]]
! [[Platelet count]]
|-
| [[Vitamin K deficiency]] or [[warfarin]]
| '''Prolonged'''
| '''Normal or mildly prolonged'''
| Unaffected
| Unaffected
|-
| [[Disseminated intravascular coagulation]]
| '''Prolonged'''
| '''Prolonged'''
| '''Prolonged'''
| '''Decreased'''
|-
| [[Von Willebrand disease]]
| Unaffected
| '''Prolonged or unaffected'''
| '''Prolonged'''
| Unaffected
|-
| [[Hemophilia]]
| Unaffected
| '''Prolonged'''
| Unaffected
| Unaffected
|-
| [[Aspirin]]
| Unaffected
| Unaffected
| '''Prolonged'''
| Unaffected
|-
| [[Thrombocytopenia]]
| Unaffected
| Unaffected
| '''Prolonged'''
| '''Decreased'''
|-
| [[Liver failure]], early
| '''Prolonged'''
| Unaffected
| Unaffected
| Unaffected
|-
| Liver failure, end-stage
| '''Prolonged'''
| '''Prolonged'''
| '''Prolonged'''
| '''Decreased'''
|-
| [[Uremia]]
| Unaffected
| Unaffected
| '''Prolonged'''
| Unaffected
|-
| [[Congenital afibrinogenemia]]
| '''Prolonged'''
| '''Prolonged'''
| '''Prolonged'''
| Unaffected
|-
| [[Factor V]] deficiency
| '''Prolonged'''
| '''Prolonged'''
| Unaffected
| Unaffected
|-
| [[Factor X]] deficiency as seen in [[amyloid purpura]]
| '''Prolonged'''
| '''Prolonged'''
| Unaffected
| Unaffected
|-
| [[Glanzmann's thrombasthenia]]
| Unaffected
| Unaffected
| '''Prolonged'''
| Unaffected
|-
| [[Bernard–Soulier syndrome]]
| Unaffected
| Unaffected
| '''Prolonged'''
| '''Decreased or unaffected'''
|-
| [[Factor XII#Role in disease|Factor XII deficiency]]
| Unaffected
| '''Prolonged'''
| Unaffected
| Unaffected
|-
| [[Hereditary angioedema|C1INH deficiency]]
| Unaffected
| '''Shortened'''
| Unaffected
| Unaffected
|}

==Treatments==
Consult a [[hematologist]] and have regular blood check ups. Have an early diagnostic test for any blood disorders or blood diseases including hemophilia, hemorrhage, and sickle-cell anemia. [[Prothrombin time]] and [[partial thromboplastin time]] blood tests are useful to investigate the reason behind the excessive bleeding. The PT evaluates coagulation factors '''I, II, V, VII and X''', while the PTT evaluates coagulation factors '''I, II, V, VIII, IX, X, XI and XII'''. The analysis of both tests thus helps to diagnose certain disorders.<ref>{{Cite web|url=https://www.walkinlab.com/prothrombintime-pt-winrandpartialthrombopla.html|title=Prothrombin Time (PT) w/INR and Partial Thromboplastin Time (PTT) Blood Test|website=Walk-In Lab|language=en|access-date=2018-09-17}}</ref>

[[Blood transfusion]] involves the transfer of plasma containing all the necessary coagulating factors ([[fibrinogen]], [[Thrombin|prothrombin]], [[thromboplastin]]) to help restore them and to improve the immune defense of the patient after excessive blood loss. Blood transfusion also caused the transfer of [[platelet]]s that can work along with coagulating factors for blood clotting to commence.<ref>{{Cite web|url=https://iliveok.com/health/hemorrhagic-diathesis_109599i15942.html|title=Hemorrhagic diathesis: causes, symptoms, diagnosis, treatment {{!}} Competently about health on iLive|website=iliveok.com|access-date=2018-09-17}}</ref>

Different drugs can be prescribed depending on the type of disease. Vitamins (K, P and C) are essential in case of obstruction to walls of blood vessels. Also, vitamin K is required for the production of blood clotting factors, hence the injection of vitamin K ([[phytomenadione]]) is recommended to boost blood clotting.<ref>{{Cite news|url=https://www.netdoctor.co.uk/medicines/heart-blood/a25886/treatments-for-bleeding-disorders/|title=Treatments for bleeding disorders|date=2015-11-03|work=Netdoctor|access-date=2018-09-17|language=en-GB}}</ref>

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== References ==
{{Reflist}}

== External links ==
{{Medical resources
| DiseasesDB     = 1442
| ICD10          = {{ICD10|D|69|9|d|65}}
| ICD9           = {{ICD9|287.9}}
| ICDO           =
| OMIM           =
| MedlinePlus    =
| eMedicineSubj  =
| eMedicineTopic =
| MeshID         = D006474
}}
{{Diseases of megakaryocytes|us=y}}

{{DEFAULTSORT:Bleeding Diathesis}}
[[Category:Bleeding]]
[[Category:Coagulopathies]]