MILD BLEEDERS: DIAGNOSIS IS ELUSIVE IN LARGE NUMBER OF PATIENTS

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Mrinalini kotru
Deepti Mutereja
Abhishek Purohit
Seema Tyagi
Manoranjan Mahapatra
Renu Saxena
Hara Prasad Pati

Keywords

Mild Bleeders, VWD, Platelet function defects, Hemophilia, Diagnosis

Abstract

Abstract. Background: Bleeding is a common clinical presentation. Even patients with mild bleeding disorders are extensively investigated for ascertaining the cause. The present study was conducted in order to evaluate the extent of the possibility of diagnosis in mild bleeding disorders.

Material and Methods: This was a prospective study of patients referred for work up of mild bleeding for a period of 13 months. A complete blood count, peripheral smear examination, Prothrombin time, Partial Thromboplastin time and Thrombin Time, Platelet Aggregometry test, tests for von Willebrand’s disease and Platelet function 3 availability were measured.

Results: 164 patients presented with mild bleeding, in 114 of the  patients a single site of bleeding was present. Epistaxis was the most common presentation (39%). Cutaneous bleeding (petechiae and purpura) was the next common site. History of a major bleeding tendency in the family was present only in 11 patients. The investigations showed that VWD (17/164), followed by clotting disorders (CD) mainly mild hemophilia (15/164) were the most common diagnosable cause. There were also 4 cases of hypofibrinogenemia. The disorders of platelets (Platelet function defects/PFD) were the least common (9/164). Rest 123 (75%) patients could not be diagnosed on the basis of these investigations and were labeled as  Bleeding disorders – Unclassified (BDC).

Conclusion: n our study, 75% of the patients with mild bleeding remained undiagnosed even after extensive laboratory workup, thus raising a very pertinent question that is it necessary that all mild bleeders submit to a broad battery of investigations, as the diagnosis continues to be elusive despite extensive workup.

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Abstract 2703 | PDF Downloads 360 HTML Downloads 580 Figure 1 Distribution of the various causes of mild bleeding (in %) in males and females Downloads 0 Figure 2 Age and Sex distribution of patients with Bleeding disorders- Unclassified Downloads 0 Table : Distribution of the sites of bleeding and their causes Downloads 0

References

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