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Acquired Bleeding Disorders/Platelet Disorders

Disseminated Intravascular Coagulation (Dic) 

Disseminated intravascular coagulation (DIC) is a pathologic, excessive generation of thrombin and fibrin in the circulating blood. During the process, increased platelet aggregation and coagulation factor consumption occur this does not allow time for compensatory increase in production of coagulant and anticoagulant factors. 


Diagnostic Criteria

  • Usually are related to the underlying disorder to the DIC or both

  • Bleeding manifestation,

  • Extensive organ dysfunction, 

  • Shock, renal cortical ischemia, coma, delirium and focal neurological symptoms. 

Non-Pharmacological Treatment

Rapid and appropriate treatment of the underlying disorder, including antibiotics for infection, surgical debridement of necrotic tissues, chemotherapy for acute leukemia, of evacuation of dead fetus; transfusion with platelets support for thrombocytopenia, fresh frozen plasma (FFP) for coagulation factor depletion and cryoprecipitate for hypofibrinogenemia


Multifactor deficiency, Liver disease gives Fresh Frozen Plasma 10-15mls/kg until bleeding is stoped 


  • Monitor prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin (APTT), platelet count and fibrinogen.

  • Identify and treat the cause for example infection, Leukaemia especially Acute PromyelocyticLeukaemia, sereve burn, Abraptio placenta

  • Vitamin K deficiency 

CAUTION: 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.

Idiopathic thrombocytopenic Purpura (ITP)

Idiopathic thrombocytopenic Purpura is an acquired disease of children and adults and defined as isolated thrombocytopenia with no clinically apparent associated condition or other causes of thrombocytopenia. The diagnosis relies on exclusion of other causes of thrombocytopenia. 

Clinical feature for adult thrombocytopenia appears to be more common in young women than in young men but among older patients, the sex incidence may be equal. Most adult patient presents with a long history of Purpura, menorrhagia, epistaxis and gingival haemorrhage are more common. Intracerebral haemorrhage occurs infrequently but is the most cause of death overt bleeding is rare unless thrombocytopenia severe (less than 10,000/µl) 

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


Patients who are incidentally discovered to have asymptomatic mild or moderate ITP can safely be followed with no treatment. Patients with platelet counts over 50,000/µl usually do not have spontaneous bleeding and may undergo invasive procedure. Emergenct treatment of acute bleeding caused by severe thrombocytopenia need immediate platelet transfusion is indicated in patient with haemorrhagic emergencie



Pharmacological Treatment    


Prednisolone 1mg/kg/day (PO) for 3–6 months then taper 10mg weekly (For all patients with platelet counts below 30,000 to 50,000µl)  OR

IV Immunoglobulin may be given as a single dose infusion of 0.41.0g/kg followed by immediately platelets transfusion 1 mg/kg/day for 7 days and tapered over a week 

Surgical Management

Splenectomy is indicated in patient with refractory to prednisolone. 

Last updated on, 27.10.2020

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