Bleeding Diathesis

  • Ronald N. Rubin
  • Kalyani Narra


After studying this chapter, you should be able to: Know the history, physical examination, and laboratory tests useful in assessing the bleeding patient. Be aware of the disorders of vascular and tissue components and platelet dysfunction as they relate to bleeding diathesis. Evaluate patients with disorders of platelet immune destruction. Diagnose hereditary and acquired coagulation disorders found in intensive care unit patients.


Factor VIII Disseminate Intravascular Coagulation Partial Thromboplastin Time Thrombotic Thrombocytopenic Purpura Immune Thrombocytopenic Purpura 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    George JN, Woolf SH, Raskob GE, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996;88:3-40.PubMedGoogle Scholar
  2. 2.
    Kuter DJ, Bussel JB, Lyons RM, et al. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomized controlled trial. Lancet. 2008;371(9610):395-403.PubMedCrossRefGoogle Scholar
  3. 3.
    Bussel JB, Cheng G, Saleh MN, et al. Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura. N Engl J Med. 2007;357(22):2237-2247.PubMedCrossRefGoogle Scholar
  4. 4.
    George JN, Raskob GE, Shah SR, et al. Drug-induced thrombocytopenia: a systemic review of published case reports. Ann Intern Med. 1998;129(11):886-890.PubMedGoogle Scholar
  5. 5.
    Aster RH, Bougie DW. Drug-induced immune thrombocytopenia. N Engl J Med. 2007;357(6):580-587.PubMedCrossRefGoogle Scholar
  6. 6.
    Warkentin TE, Sheppard JI, Horsewood P, et al. Impact of the patient population on the risk for heparin-induced thrombocytopenia. Blood. 2000;96(5):1703-1708.PubMedGoogle Scholar
  7. 7.
    Arepally GM. Clinical practice. Heparin-induced thrombocytopenia. N Engl J Med. 2006;355(8):809-817.PubMedCrossRefGoogle Scholar
  8. 8.
    Liebman HA, Stasi R. Secondary immune thrombocytopenic purpura. Curr Opin Hematol. 2007;14(5):557-573.PubMedCrossRefGoogle Scholar
  9. 9.
    Aird WC. The hematologic system as a marker of organ dysfunction in sepsis. Mayo Clin Proc. 2003;78(7):869-881.PubMedCrossRefGoogle Scholar
  10. 10.
    McHutchison JG, Dusheiko G, Shiffman ML, et al. Eltrombopag for thrombocytopenia in patients with cirrhosis associated with hepatitis C. N Engl J Med. 2007;357(22):2227-2236.PubMedCrossRefGoogle Scholar
  11. 11.
    George JN. Clinical practice. Thrombotic thrombocytopenic purpura. N Engl J Med. 2006;354(18):1927-1935.PubMedCrossRefGoogle Scholar
  12. 12.
    Furlan M, Robles R, Galbusera M, et al. Von Willebrand factor-cleaving protease in thrombotic thrombocytopenic purpura and hemolytic-uremic syndrome. N Engl J Med. 1998;339(22):1578-1584.PubMedCrossRefGoogle Scholar
  13. 13.
    George JN. How I treat patients with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Blood. 2000;96(4): 1223-1229.PubMedGoogle Scholar
  14. 14.
    Mannucci PM. Treatment of von Willebrand’s disease. N Engl J Med. 2004;351(7):683-694.PubMedCrossRefGoogle Scholar
  15. 15.
    George JN, Shattil SJ. The clinical importance of acquired abnormalities of platelet function. N Engl J Med. 1991;324(1):27-39.PubMedCrossRefGoogle Scholar
  16. 16.
    Hassan AA, Kroll MH. Acquired disorders of platelet function. Hematology Am Soc Hematol Educ Program. 2005;403-408.Google Scholar
  17. 17.
    Kamal AH, Tefferi A, Pruthi RK. How to interpret and pursue an abnormal prothrombin time, activated partial thromboplastin time, and bleeding time in adults. Mayo Clin Proc. 2007;82(7):864-873.PubMedCrossRefGoogle Scholar
  18. 18.
    Mannucci PM, Tuddenham EG. The hemophilias–from royal genes to gene therapy. N Engl J Med. 2001;344(23):1773-1779.PubMedCrossRefGoogle Scholar
  19. 19.
    Furie B, Limentani S, Rosenfeld CG. A practical guide to the evaluation and treatment of hemophilia. Blood. 1994;84(1):3-9.PubMedGoogle Scholar
  20. 20.
    Addonizio VP. Platelet function in cardiopulmonary bypass and artificial organs. Hematol Oncol Clin North Am. 1990;4(1):145-155.PubMedGoogle Scholar
  21. 21.
    Woodman RC, Harker LA. Bleeding complications associated with cardiopulmonary bypass. Blood. 1990;76(9):1680-1697.PubMedGoogle Scholar
  22. 22.
    Hirsh J, Raschke R. Heparin and low-molecular-weight heparin: the seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 suppl):188S-203S.PubMedCrossRefGoogle Scholar
  23. 23.
    Penner JA. Managing the hemorrhagic complications of heparin administration. Hematol Oncol Clin North Am. 1993;7(6):1281-1289.PubMedGoogle Scholar
  24. 24.
    Ansell J, Hirsh J, Poller L, et al. The pharmacology and management of the vitamin K antagonists: the seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 suppl):204S-233S.PubMedCrossRefGoogle Scholar
  25. 25.
    Crowther MA, Warkentin TE. Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Blood. 2008;111(10): 4871-4879.PubMedCrossRefGoogle Scholar
  26. 26.
    Mammen EF. Coagulation abnormalities in liver disease. Hematol Oncol Clin North Am. 1992;6(6):1247-1257.PubMedGoogle Scholar
  27. 27.
    Levi M, Ten Cate H. Disseminated intravascular coagulation. N Engl J Med. 1999;341(8):586-592.PubMedCrossRefGoogle Scholar
  28. 28.
    Rubin RN, Colman RW. Disseminated intravascular coagulation. Approach to treatment. Drugs. 1992;44(6):963-971.PubMedCrossRefGoogle Scholar
  29. 29.
    Lee GR et al. Wintrobe’s Clinical Hematology. 9th ed. Philadelphia: Lea & Febiger; 1993:1309.Google Scholar


  1. Tefferi A, Hanson CA, Inwards DJ. How to interpret and pursue an abnormal complete blood cell count in adults. Mayo Clin Proc. 2005;80(7):923-936.PubMedCrossRefGoogle Scholar
  2. Mannucci PM, Levi M. Prevention and treatment of major blood loss. N Engl J Med. 2007;356(22):2301-2311.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Ronald N. Rubin
    • 1
  • Kalyani Narra
    • 2
  1. 1.Division of HematologyTemple University School of MedicinePhiladelphiaUSA
  2. 2.Department of HematologyTemple University School of MedicinePhiladelphiaUSA

Personalised recommendations