Classification of bleeding disorders

Key facts

• Three processes stop bleeding
  1. vasoconstriction
  2. platelet plugging
  3. coagulation
• Bleeding disorder can be classified into these three categories (see below)
• The pattern of bleeding is important
  • Vascular and platelet disorders → prolonged bleeding from cuts, bleeding into the skin (eg easy bruising and purpura), and bleeding from mucous membranes (eg epistaxis, bleeding from gums, menorrhagia)
  • Coagulation disorder → delayed bleeding into joints and muscle

Bleeding classification

Vascular defects

1. Congenital
   • Osler-Weber-Rendu syndrome (aka Hereditary haemorrhagic telangiectasia)
   • Connective tissue disease (eg Ehlers-Danlos syndrome, pseudoxanthoma elasticum)
2. Acquired
   • Infection- e.g. meningococcal, measles, dengue fever
   • Drugs- e.g. steroids, sulphonamides
   • Immune- Henoch-Schönlein purpura
   • Others- Senile purpura, scurvy (perifollicular haemorrhages)

Platelet disorders

1. Decreased marrow production
   • Aplastic anaemia
   • Megaloblastic anaemia
   • Marrow infiltration (e.g. leukaemia, myeloma)
   • Marrow suppression (cytotoxic drugs, radiotherapy).
2. Excess destruction
   • Immune: immune thrombocytopenia (ITP), other autoimmune causes, e.g. SLE, CLL, drugs, e.g. heparin, viruses
   • Non-immune: DIC, thrombotic thrombocytopenic purpura (TTP), or HUS, sequestration (in hypersplenism)
3. Poorly functioning platelets
   • Myeloproliferative disease
   • Nsaids
   • ↑Urea

Coagulation disorders

1. Congenital
   • Haemophilia
   • von Willebrand’s disease
2. Acquired
   • Anticoagulants
   • DIC
   • Liver disease
   • Vitamin K deficiency