Coagulopathy, general

• PTT measures all factors except 7 and 13
• PT measures 2, 5, 7, 10, and 1
• Vit K dependent factors are: 2, 7, 9, 10, 12, prot C & S, HMWK, pre-K
• non-vit K dependent: 5, 8, fibrinogen

Classic presentations of bleeding disorders by age:

• Newborn: Bleeding with cord seperation, circumcision, into scalp and brain
• Toddlers: Superficial bruising and deep tissue bleeding beyond expected
• Teenage females: menorrhagia

Hemophilia
Congenital Afibrinogenemia/ Dysfibrinogenemias
Congenital Factor 2 (Prothrombin), 5,7 deficiency: Variable presentation, depending on degree of deficiency
Factor 11 deficiency
Factor 12 deficiency: Causes Prolonged PTT, but no clinical bleeding; more common in Asian population
Factor 13 deficiency
Von Willebrand Disease
Vit K deficiency, Bleeding in the newborn
Platelet disorders
Fanconi's Anemia/Pancytopenia
Mom with ITP, Infection/DIC, Drugs.

Algorithm

1. Hx of bleed? Screen with CBC, PT, PTT
2. Superficial cutaneous or mucous membrane bleeding?
   1. what two lab tests do you do?
3. Soft tissue hematoma, deep internal hemorrhage, or hemarthrosis? what other test will help?
   1. PTT prolonged, PT normal
   2. PTT normal, PT prolonged
   3. Both PTT and PT prolonged
   4. Both PTT and PT normal