Acquired Bleeding Disorders/Platelet Disorders

Clinical features 

• Usually are related to the underlying disorder. 
• Bleeding manifestation, 
• Extensive organ dysfunction,  
• Shock, renal cortical ischemia, coma, delirium and focal neurological symptoms. 

Pharmacological Treatment 

Rapid and appropriate treatment of the underlying disorder including; 

• Antibiotics for infection, 
• Surgical debridement of necrotic tissues,  
• Chemotherapy for malignant causes,  
• Evacuation of dead fetus;  
• Platelets transfusion for thrombocytopenia,  
• Fresh frozen plasma (FFP) for coagulation factor depletion.  
• Monitor  prothrombin  time  (PT),  international  normalized  ratio  (INR),  activated  partial thromboplastin (aPTT), platelet count and fibrinogen. 

Note: If patient is not bleeding Platelets concentrate is contraindicated. If DIC is severe enough to  cause multiorgan dysfunction, management in an intensive care unit is required

Clinical features: 

• long history of Purpura, menorrhagia, epistaxis and gingival haemorrhage.
• Intracerebral haemorrhage occurs infrequently but is the most cause of death
• overt bleeding is rare unless thrombocytopenia severe (less than 10 X10⁹/L)

Note: A palpable spleen strongly suggests that ITP is NOT the cause for thrombocytopenia. 

Non-pharmacological Treatment 

• Patients with platelet counts over 50 X10⁹/L usually do not have spontaneous bleeding and may undergo invasive procedure.
• Emergency  treatment  of  acute  bleeding  caused  by  severe  thrombocytopenia  need immediate platelet transfusion

Pharmacological Treatment 

A: prednisolone (PO) 1mg/kg/day for 3–6 weeks, then taper 10mg weekly (For all patients with platelet counts below 30 X10⁹/L) 

OR  

B:  dexamethasone  (IV)  40mg  in  500ml  Normal  saline  running  for  4hours  once  a  day  for 4days. 

If no response; 

S:human Immunoglobulin G (IV) 0.4g/kg/day for 5days, 

OR 

S:human  Immunoglobulin  G  (IV)  1g/kg/day  for  2days  followed  by  immediately  platelets transfusion