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BLEEDING DIATHESES / EASY BRUISING |
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INCREASED VESSEL FRAGILITY [normal platelets and coagulation pathway; causing purpura or petechiae, especially over dependent areas; epistaxis; menorrhagia; gastrointestinal bleeding] |
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vasculitides: |
infective: |
typhus and other rickettsioses meningococcaemia septicaemia infective endocarditis typhoid measles viral haemorrhagic fevers, eg. dengue |
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hypersensitivity: |
drug reactions Henoch-Schönlein purpura uraemia liver failure |
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acquired skin defects: |
severe vitamin C deficiency [scurvy; usually in malnourished elderly]senility (atrophic skin) |
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congenital / hereditary skin defects: |
Ehlers-Danlos syndrome type IV pseudoxanthoma elasticum hereditary haemorrhagic telangiectasia (peri-oral and git) |
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other: |
fat embolism (fine petechiae)purpura simplex |
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PLATELET PROBLEMS [prolonged bleeding time; normal platelets and coagulation pathway; causing purpura or petechiae; gastrointestinal bleeding; menorrhagia; epistaxis]: |
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thrombasthenia [abnormal platelet function]: |
acquired platelet defects: uraemia liver disease aspirin systemic lupus erythematosus chronic myeloid leukaemia, myeloma, myelodysplasia thrombocythaemia |
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rare inherited disorders: von Willebrand's disease 1° thrombasthenias: Wiscott-Aldrich syndrome [sex-linked; + eczema + immunosuppression] platelet storage pool disease Glanzman's syndrome Bernard-Soulier syndrome |
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COAGULATION DEFECTS [PROLONGED APTT and / or INR; causing bleeding into muscle and joints, bruising, severe peri-operative bleeding, etc.]: |
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acquired [deficiency of vitamin K-dependent factors, ie. II, VII, IX and X]: |
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vitamin K deficiency: |
in new-born [= haemorrhagic disease of new-born]nutritional chronic liver disease coumarin drugs |
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other: |
disseminated intravascular coagulation ('consumption coagulopathy')[PROLONGED APTT / INR; both thrombosis and bleeding occur; bleeding predominates in 'acute' DIC, thrombosis in 'chronic' DIC (eg. associated with malignancy); multiple pathology / causes] |
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hereditary [single factor deficient]: |
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haemophilia A (VIIIc) haemophilia B (IX; 'Christmas disease') von Willebrand's disease [also defects with platelet and capillary function] other (rarer) defects, eg. factor XI deficiency |
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