Approach To The Patient With Rectal Bleeding
John P. Papp in Endoscopie Control of Gastrointestinal Hemorrhage, 2019
Blood volume determination is the most accurate parameter for measuring the amount of blood loss. Even though the hematocrit does not immediately reflect changes in blood volume, it is valuable for following the rate of bleeding. An elevated blood urea nitrogen indicates resorption of blood in the upper intestinal tract. Luekocytosis is caused by any inflammatory process, such as infection, inflammation, or ischemia. However, sudden blood loss may stimulate an immediate bone marrow response with an elevation in the peripheral white-blood cell count. Screening tests for a possible bleeding diathesis should be performed with abnormalities sought in the prothrombin time and platelet count. Tests for the detection of occult blood in the stool must be a regular part of every patient examination. A positive result cannot be ignored. These tests are readily and easily performed by either the patient or the physician.
A Systematic Approach To The Diagnosis Of Bleeding Disorders
Genesio Murano, Rodger L. Bick in Basic Concepts of Hemostasis and Thrombosis, 2019
A bleeding diathesis can rarely be completely defined without the aid of laboratory tests, but the selection and interpretation of these tests should be predicted on the basis of major clinical data. A careful history is therefore paramount, with particular emphasis on the family history. Drug administration, obvious or surreptitious, must be carefully considered. Detailed discussions of drugs affecting hemostasis are found in Chapters 5, 6, and 7. A history of obstetrical and surgical events associated with unusual bleeding require a search for defects in hemostasis. Vascular or platelet abnormalities usually manifest as easy and spontaneous bruisability, petechiae or purpura, commonly dependent, and bleeding from the mucous membranes, although the hereditary disorders may present primarily as gastrointestional bleeding. Conversely, the hemophilias rarely, if ever, cause petechiae or purpura, but joint bleeding is a hallmark. In an age of social awareness, a note of caution seems warranted concerning the “battered child syndrome”. Idiopathic thrombocytopenic purpura, a disease most commonly seen in children, may simulate this condition because of the painful associated hematomas. The presence of blue sclerae, hyperelasticity of the skin, and hyper-extensible joints suggest a hereditary connective tissue disorder. Telangiectasia of buccal mucosal membranes or subungual areas is a classic finding in Osler-Weber-Rendu disease. Splenic enlargement most often suggest thrombocytopenia, usually secondary.
Neurological Dengue
Sunit K. Singh, Daniel Růžek in Neuroviral Infections, 2013
General medical management of intracranial hemorrhage is largely supportive. Cerebral autoregulation is impaired in the acute phase so adjustments to blood pressure (which is often high) should be avoided for fear of compromising perfusion. As to specific data on the management of intracranial hemorrhage in dengue, there is little available evidence. It is unclear to what extent dengue hemorrhagic encephalopathy reflects damage to cerebral vascular endothelium, bleeding diathesis, or exacerbation of preexisting cerebrovascular disease. However, as the bleeding diathesis likely plays at least some role, it would seem reasonable to correct the clotting abnormalities, and some groups have used platelet transfusion for this purpose (Kumar et al. 2009). In some cases it may be appropriate to use fresh frozen plasma (FFP), prothrombin complex concentrate (PCC), or even activated factor VII (fVIIa). A large hemorrhage may cause a significant mass effect, especially in the confined space of the posterior fossa, and if there are signs of raised intracranial pressure it may be necessary to perform a decompressive craniectomy or urgent CSF shunting.
Can bipolar energy serve as an alternative to monopolar energy in the management of large bladder tumours >3 cm? A prospective randomised study
Published in Arab Journal of Urology, 2019
Mahmoud A. Mahmoud, Ahmed Tawfick, Diaa Eldin Mostafa, Hossam Elawady, Mohamed Abuelnaga, Karim Omar, Hisham Elshawaf, Mohamed Hasan
Exclusion criteria: Unfitness for spinal anaesthesia.Patients with recurrent bladder tumour.Patients with other urological malignancies.Patients requiring anticoagulation.Patients with pacemakers.Patients with back pressure change.Patients with urethral stricture.Active UTIs.Patients with uncontrolled bleeding diathesis.
Genetic variants associated with Hermansky-Pudlak syndrome
Published in Platelets, 2020
Melissa A. Merideth, Wendy J. Introne, Jennifer A. Wang, Kevin J. O’Brien, Marjan Huizing, Bernadette R. Gochuico
A bleeding diathesis is found in HPS patients irrespective of genetic type, other phenotypic features are dependent upon HPS type. Recurrent infections due to neutropenia and/or immunodeficiency may develop in patients with HPS types 2 or 10, and neutropenia generally responds to treatment with G-CSF [18,19]. Pulmonary fibrosis is diagnosed in patients with HPS types 1, 2, or 4 [2,3,20]. Adults with HPS type 1 may present with progressive fibrotic lung disease in middle age, and children and young adults with HPS type 2 may develop pulmonary fibrosis [2,3,20]. Results of clinical trials investigating pirfenidone as treatment for HPS pulmonary fibrosis were inconclusive [21,22], and thus medical therapy approved as treatment for HPS pulmonary fibrosis is not available. Single or double lung transplantation has been successfully performed on several patients with HPS, and it remains an option for certain candidates with severe HPS pulmonary fibrosis [23].
Clinical manifestations and treatments of Protobothrops mucrosquamatus bite and associated factors for wound necrosis and subsequent debridement and finger or toe amputation surgery
Published in Clinical Toxicology, 2021
Yan-Chiao Mao, Po-Yu Liu, Liao-Chun Chiang, Chi-Hsin Lee, Chih-Sheng Lai, Kuo-Lung Lai, Wen-Loung Lin, Hung-Yuan Su, Cheng-Hsuan Ho, Uyen Vy Doan, Tri Maharani, Yi-Yuan Yang, Chen-Chang Yang
Although ecchymosis is frequently described in P. mucrosquamatus bites [6,9], it is usually limited around the wound, probably because the anticoagulant effect is weak [55], despite high proportion of hemorrhagic SVMPs in the venom [47]. In this study, bleeding diathesis was not observed; however, we could not exclude the possibility that bleeding diathesis might develop if antivenom was not promptly administered. Even though early antivenom administration (<6 h) was not associated with a lower incidence of coagulopathy in our study, all of our patients received antivenom within 25.5 h after the bite, which might have halted the late-onset coagulopathy that would occur several days later. If specific antivenom is unavailable, we suggest close monitoring of the patients for bleeding up to 1 week. Thrombocytopenia is uncommon after P. mucrosquamatus bite and typically not severe. The mechanism may involve platelet aggregation/agglutination and the effect of SVMPs on the microvessel wall to induce platelet sequestration [59,60,63,64].
Related Knowledge Centers
- Hematology
- Bleeding
- Coagulopathy
- Coagulation
- Platelet
- Cushing'S Syndrome
- Wound Healing
- Anticoagulant
- Warfarin
- Liver Failure