Monday, October 24, 2016

A Brief Discussion On Clotting Disorders

Disorders of clotting may be congenital or acquired.
Clotting disorder is a condition in which the blood's ability to coagulate (form clots) is impaired. This can cause a tendency toward prolonged or excessive bleeding which may occur spontaneously or following an injury or medical and dental procedures. 


hemarthroses in a patient with hemophillia


Causes: 

Congenital: 

  • Hemophillia
  • von Willebrand's disease. 
Acquired: 
  • Vitamin K deficiency.
                - Hemorrhagic disease of the newborn
                - Obstructive jaundice
                - Fat malabsorption
  • Liver disease
  • Disseminated intravascular coagulation
  • Autoimmune disease e.g SLE
  • Massive transfusion
  • Drugs
               - Heparin
               - Warfarin
               - Thrombolytic therapy. 

Clinical History: 

1. Onset and Duration: The duration of symptoms and age of presentation is very useful in determining the underlying etiology. Bleeding in the first few days of life occurs as a result of deficient vitamin K synthesis by the neonatal liver, due to immaturity. Patients with hemophillia usually present at a young age with excessive blood loss following injuries or surgical procedures , such as circumcision. Muscle hematomas and painful hemarthroses may be accompanying features. 

2. Past Medical History: Underlying medical conditions may be a reason for many of the acquired clotting disorders for example diseases of the liver like chronic hepatitis C may predispose to bleeding as the clotting factors synthesis in liver is impaired. 
Vitamin K is a fat soluble vitamin essential for the production of clotting factors II, VII, IX & X. Conditions such as obstructive jaundice, pancreatic or small bowel disease that impairs the absorption of fat will result in decreased production of the vitamin K dependent clotting factors and resulting clotting defect. 
Patients with autoimmune diseases like SLE may produce antibodies such as lupus anticoagulant which may predispose to clotting disorders.
Severe infections, malignancy, obstetric complications and burns may lead to DIC characterized by widespread consumption of clotting factors and platelets, resulting in severe coagulation disturbances. 

3. Drug History:  Coagulation abnormalities may be iatrogenic secondary to use of certain medications. Heparin and warfarin used for therapeutic anticoagulation may cause bleeding as a side effect. Disturbances in coagulation may result when more than the patient's normal circulating volume has been replaced by transfusion within 24 hrs. 

Examination: 
A general examination should be performed to identify any stigmata from hemophillia. Early onset osteoarthritis and pseudotumors may result from episodes of repeated hemorrhages. Skin necrosis and hematomas may be seen with warfarin overdose. In acquired coagulation disorders signs of liver disease may bring attention to the underlying disorder. 

Investigations: 

1. Complete Blood Count: Look for low platelet count which may be the cause for bleeding. (thrombocytopenia itself does not effect clotting times)

2. Clotting Screen: PT, aPTT, &TT are measures. 

3. Clotting factor assay can be done for congenital disorders like hemophilia. 

4. Fibrinogen and fibrin degradation products: In DIC, the platelet count and serum fibrinogen levels are low, whereas the fibrin degradation products such as D-dimers are increased. 



2 comments:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.

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  2. Nice blog
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    I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
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