Bleeding vs Clotting Disorders: Thrombocytopenia vs DIC vs Hemophilia
All three disorders cause bleeding, but the lab panels look completely different. Pick the wrong pattern on the NCLEX and you'll choose platelet transfusion when the patient needs cryoprecipitate — or miss that clotting and bleeding are happening simultaneously in DIC.
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Comparison
- ↓ platelet production or ↑ destruction
- ITP, HIT, chemo, hypersplenism
- Consumes platelets + clotting factors
- Triggered by sepsis, OB emergency, cancer
- Inherited factor VIII (A) or IX (B) deficiency
- X-linked recessive — males affected
- Petechiae, purpura, mucosal bleeding
- Gingival bleeding, epistaxis
- ★Bleeding AND clotting at once
- Oozing from sites + organ ischemia
- ★Deep tissue & joint bleeds (hemarthrosis)
- Prolonged bleeding after minor injury
- Isolated ↓ platelets (< 150,000)
- PT, aPTT, fibrinogen, D-dimer normal
- ↑ PT/aPTT, ↓ fibrinogen, ↓ platelets
- ↑ D-dimer (fibrinolysis)
- ★Prolonged aPTT only
- Normal PT, platelets, fibrinogen
- Bleeding precautions
- avoid ASA/NSAIDs
- ★If HIT — stop ALL heparin
- Treat the underlying cause
- Assess all lines/sites
- watch for thrombosis
- No IM injections
- apply prolonged pressure
- Assess joints for swelling, ROM loss
- Platelet transfusion
- Steroids/IVIG for ITP
- Replace factors: cryoprecipitate, FFP, platelets
- Heparin per protocol
- Factor VIII or IX concentrate
- Desmopressin (DDAVP) for mild hem. A
- Soft toothbrush, electric razor
- no ASA
- Avoid contact sports
- Report any new bleeding promptly
- Prophylactic factor
- RICE for bleeds
- Avoid contact sports
- Avoid IM injections
- genetic counseling
- Intracranial bleed if platelets < 20,000
- Multi-organ failure from microthrombi + hemorrhage
- Hemarthrosis then joint destruction
- ICH
- Severe hemorrhage
- HIT then thrombosis
- High mortality
- shock, organ failure
- Chronic arthropathy
- transfusion infection
Thrombocytopenia
- ↓ platelet production or ↑ destruction
- ITP, HIT, chemo, hypersplenism
DIC
- Consumes platelets + clotting factors
- Triggered by sepsis, OB emergency, cancer
Thrombocytopenia
- Petechiae, purpura, mucosal bleeding
- Gingival bleeding, epistaxis
DIC
- ★Bleeding AND clotting at once
- Oozing from sites + organ ischemia
Thrombocytopenia
- Isolated ↓ platelets (< 150,000)
- PT, aPTT, fibrinogen, D-dimer normal
DIC
- ↑ PT/aPTT, ↓ fibrinogen, ↓ platelets
- ↑ D-dimer (fibrinolysis)
Thrombocytopenia
- Bleeding precautions
- avoid ASA/NSAIDs
- ★If HIT — stop ALL heparin
DIC
- Treat the underlying cause
- Assess all lines/sites
- watch for thrombosis
Thrombocytopenia
- Platelet transfusion
- Steroids/IVIG for ITP
DIC
- Replace factors: cryoprecipitate, FFP, platelets
- Heparin per protocol
Thrombocytopenia
- Soft toothbrush, electric razor
- no ASA
- Avoid contact sports
DIC
- Report any new bleeding promptly
Thrombocytopenia
- Intracranial bleed if platelets < 20,000
DIC
- Multi-organ failure from microthrombi + hemorrhage
Thrombocytopenia
- Severe hemorrhage
- HIT then thrombosis
DIC
- High mortality
- shock, organ failure
★ marks the fact that sets a column apart.
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Normal platelets + prolonged aPTT = hemophilia; everything abnormal + clots = DIC; low platelets alone = thrombocytopenia.
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