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ETIOLOGY

 Deterioration of the relationship

between thrombocytes and vessels
 Thrombocytopenias/pathies
 Coagulation disorders
THE BLEEDING SYNDROME

DISORDERS OF THE PRIMARY

HAEMOSTASIS

 Coutaneous Ɗ mucous Purple

 Petechiaes
 Ecchymosis
THE BLEEDING SYNDROME

DISORDERS OF THE SECONDARY

HAEMOSTASIS

 Haemorrhages in deep tissues ( joints,

retroperithoneal, CNS, ORL)
 Disorders of the coagulation cascade:
haemophilias, low levels of vitamine K,
fibrinolysis
THE PRIMARY HAEMOSTASIS

V Bleeding time > 10 min.

V Thrombocytes:
= 100.000/mm3 Ɗ without
symptoms
> 50.000/mm3 Ɗ with symptoms
< 20.000/mm3 Ɗ spontaneous
haemorrhage
( risk of internal bleeding)
THE SECONDARY HAEMOSTASIS

 PTT = Partial thromboplastin time (30 Ɗ40 sec.)

 PT = prothrombin time (10 Ɗ 14 sec)
 TT = thrombin time
 Fibrinogen
 Clotƍs solubility in 5 M urea solution ( the
wholeclot is persisting after 2 hours)
 Lysis of euglobinic clot
I. THROMBOCYTOPENIC PURPLE

 Petechial purple (coutaneous-

(coutaneous-mucous):
smooth painless petechiaes
 Thrombocytopenia through central mechanism
(medullar insufficiency) or peripherical
mechanism (hyperfunction of the spleen,
IVDC)
 Prolonged bleeding time
 Deficit in clotƍs retraction
 Immunology tests: natural antibodies (lysins,
aglutinins), complement fixing antibodies

ETIOLOGY
 Idiopathic, viral, autoimmune, isoimmune
I. THROMBOCYTOPENIC PURPLE

TREATMENT

 Corticotherapy +/-
+/- immuno-
immuno-suppression
 Spleenectomy: no response to cortisone, spleen
hyperfunction
 Immunoglobulins I.v. 400 mg/kg/day
II. DISORDERS OF COAGULATION

A. HAEMOPHILIA
 Clinical features: bleedings in soft tissues /
muscles
 Lab features: thrombocytes = N
bleeding time = N
PT = N
PTT = prolonged
low prothrombin consumption

Factor VIII (N.V. = 10 g/l) and IX are correlating

with severity
A. HAEMOPHILIA

TREATMENT

V Cryoprecipitate enriched with factor VIII

V Local: sponges with fibrin, thrombin,
compressive bandage
V Adjuvant: cortisone, pain killers
V Orthopedic surgery
 B. LIVER DISEASES

 Targets: prothrombinic complex, C and S proteins,

fibrinogen, antithrombin III, factor V
 Digestive bleedings: oesophagus varicose,
ulcerations
 Lab features: PT = prolonged
PTT = prolonged
fibrinogen = low
thrombocytopenia
 Treatment : fresh plasma, prothrombinic
concentrates
(in IVDC: heparin and then plasma)
C. IVDC

 Systemic coagulation in the microcirculation

 Consumption of thrombocytes and coagulation
factors
 Exaggerated fibrinolysis:
- cutaneous and mucous bleeding lesions
- peripherical acrocyanosis
- thrombosis, pregangrenous lesions
C. IVDC

ETIOLOGY
 Important traumatisms
 Obstetrical accidents
 Metastasis
 Septicaemia

LAB FEATURES
 Thrombocytes and fibrinogen = low
 PT, TT, PTT = prolonged
 Products of degradation of fibrin = high
C. IVDC

TREATMENT

 Thrombogenical phase: HEPARIN

 Fibrinolytical Ɗ haemorrhagical phase:
 Fresh plasma
 Concentrate of thrombocytes
 +/
+/-- heparin