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bleeding disorder
Durga
History &Physical
Examination
How did you start to notice that your child has bleedig problem?
Any red spots under skin?
Epistaxis?
Gum bleeding ?
Coffee ground vomiting?
Black tarry stool?
Ask for duration of above symptoms
For intracranial bleed, ask about severe headache and
projectile vomiting
Preceding illness
Question:
Is there any history of fever with rash
before bleeding episode?(ITP)
Associated illnesses
Questions:
Did you notice any pallor in your
child?
Since when?
Was it associated with recent bleeding
In ITP, Pallor is proportionate to amount of
problem?
bledding.But pallor is worse than bleeding in case of
bone marrow failure secondary to aplastic anaemia,
Questions:
Do you notice tht the child easily gets
tired?Can he/she play like other kids?
Is there any history of
palpitation/dyspnoea on exertion or
recent loss of appetite?
Questions:
Does your child have joint or bone pain?
Does your child have any joint swelling?
Bone and joint pains and swellings are the features of
leukaemias and lymphoma. Haemathrosis of
hemophilia also causes monoarticular joint swelling
Fever
Questions:
Does your child hav any febrile
episode
during
this
period
pallor?
If
Fever can be due to infection in
so,
describe
immunocompromised
patients such as
those with aplastic anaemia,lymphoma
and leukaemia. In lymphoma and
leukaemia,the fever can be due to
malignant condition itself. Fever ie not
a feature in ITP but it can be preceded
by viral infection.
Lymphadenopathy
Question:
Does your child have lumps anywhere in the body?
(neck, groin ,abdomen)
Abdominal distention
Questions:
Do you think your childs abdomen
look distended?
It may be due to organomegaly.
Organomegaly and lymphadenopathy
are features of haematological
maligancies
Transfusion History
Question:
Has the child been transfused
before?
If so ask total bottle of blood(whole
blood,packed cells or prp),
transfusion interval, use of properly
screened blood(HBV,HIV,HCV,Malaria
and VDRL), any reaction after each
transfusion
Drug History
Question
Is there any regular medication?
If so,what sort of medication he/she
is taking?
Has your child ever taken sulphur
containing
drugs,chloramphenicol,NSAID,anti
epileptic drugs and Herbal medicine?
* causes aplastic anemia
Physical Examination
Physical examination
offers further clues to
the diagnosis
Is it bleeding?
Look for
Fixed drug eruption
Erythema nodosum
Viral exanthem
Mosquito bites
Presence of petechiae
Ecchymoses
Hematomas
Hemarthroses
Mucous
membrane
bleeding
Disorders of platelet
Clinical findings
(usually have mucous
membrane bleeding)
Disorders of coagulation
Clinical findings
(clotting factor deficiency
such as factor VIII or factor IX
deficiency)
hematomas
Hemarthrosis
Bleeding from
superficial cuts and
Scratches (often profuse)
Delayed bleeding(common)
Fixed drug
eruption
HEMATOMA
Petechiae
& Purpura
Ecchymose
s
Erythema
nodosum
Viral
exanthem
Mosquito
bites
Hemarthrosis of
elbow joint