WordNet

a characteristic likelihood of or natural disposition toward a certain condition or character or effect; "the alkaline inclination of the local waters"; "fabric with a tendency to shrink" (同)inclination
a general direction in which something tends to move; "the shoreward tendency of the current"; "the trend of the stock market" (同)trend
the flow of blood from a ruptured blood vessel (同)hemorrhage, haemorrhage

PrepTutorEJDIC

『傾向』 / 『性癖』,癖
出血する / 出血;放血

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/05/14 23:05:45」(JST)

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In medicine (hematology), bleeding diathesis (or bleeding tendency or predisposition or ha(e)morrhagic diathesis) is an unusual susceptibility to bleeding (hemorrhage) mostly due to hypocoagulability, in turn caused by a coagulopathy (a defect in the system of coagulation). Several types are distinguished, ranging from mild to lethal. Also, bleeding diathesis can be caused by thinning of the skin or impaired wound healing.

Hypocoagulability [edit]

Hypocoagulability is a bleeding diathesis caused by coagulopathy.

Causes [edit]

While there are several possible causes, they generally result in excessive bleeding and a lack of clotting.

Acquired [edit]

Acquired causes of coagulopathy include anticoagulation with warfarin, liver failure, Vitamin K deficiency and disseminated intravascular coagulation.

Additionally, the haemotoxic venom from certain species of snakes can cause this condition, for example Bothrops, rattlesnakes and other species of viper. Viral hemorrhagic fevers include dengue hemorrhagic fever and Dengue Shock Syndrome

Leukemia may also cause coagulopathy.

Autoimmune causes of acquired coagulation disorders [edit]

There are autoimmune causes of coagulation disorders. They include acquired antibodies to coagulation factors, termed inhibitors of coagulation. The main inhibitor is directed against clotting Factor VIII. Another example is antiphospholipid syndrome an autoimmune, hypercoagulable state.

Genetic [edit]

Some people lack genes that typically produce the protein coagulation factors that allow normal clotting. Various types of Hemophilia and von Willebrand disease are the major genetic disorders associated with coagulopathy.

Rare examples are Bernard-Soulier syndrome, Wiskott-Aldrich syndrome and Glanzmann's thrombasthenia.

Generally if one parent has a type of Bleeding Diathesis it there is a 95% chance of passing onto their offspring.

Symptoms [edit]

Symptom	Disorders
Petechiae (red spots)	Wiskott-Aldrich syndrome, where they may resemble a few bruises^[1] Acute leukemia^[2] Chronic leukemia^[2] Vitamin K deficiency^[3]
Purpura and ecchymoses	Acute leukemia^[2] Chronic leukemia^[2] Vitamin K deficiency^[3]
Blood in stool	Wiskott-Aldrich syndrome, especially in infancy^[1] Acute leukemia^[2]
Bleeding gingiva (gums)	Wiskott-Aldrich syndrome^[1] Acute leukemia^[2] Chronic leukemia^[2]
Prolonged nose bleeds	Wiskott-Aldrich syndrome^[1]

Complications [edit]

Following are some complications of coagulopathies, some of them caused by their treatments:

Complication	Disorders
Soft tissue bleeding, e.g. deep-muscle bleeding, leading to swelling, numbness or pain of a limb.	Hemophilia^[4] Von Willebrand disease ^[5]
Joint damage, potentially with severe pain and even destruction of the joint and development of arthritis	Hemophilia^[4] Von Willebrand disease ^[5]
Retinal bleeding	Acute leukemia^[2]
Transfusion transmitted infection, from blood transfusions that are given as treatment.	Hemophilia^[4]
Adverse reactions to clotting factor treatment.	Hemophilia^[4]
Anemia	Von Willebrand disease ^[5]
Exsanguination (bleeding to death)	Von Willebrand disease ^[5] Acute leukemia^[2] Vitamin K deficiency^[3]
Cerebral hemorrhage	Wiskott-Aldrich syndrome^[1]

Comparing coagulation tests [edit]

Laboratory findings in various platelet and coagulation disorders (V - T)
Condition	Prothrombin time	Partial thromboplastin time	Bleeding time	Platelet count
Vitamin K deficiency or warfarin	Prolonged	Normal or mildly prolonged	Unaffected	Unaffected
Disseminated intravascular coagulation	Prolonged	Prolonged	Prolonged	Decreased
Von Willebrand disease	Unaffected	Prolonged	Prolonged	Unaffected
Hemophilia	Unaffected	Prolonged	Unaffected	Unaffected
Aspirin	Unaffected	Unaffected	Prolonged	Unaffected
Thrombocytopenia	Unaffected	Unaffected	Prolonged	Decreased
Liver failure, early	Prolonged	Unaffected	Unaffected	Unaffected
Liver failure, end-stage	Prolonged	Prolonged	Prolonged	Decreased
Uremia	Unaffected	Unaffected	Prolonged	Unaffected
Congenital afibrinogenemia	Prolonged	Prolonged	Prolonged	Unaffected
Factor V deficiency	Prolonged	Prolonged	Unaffected	Unaffected
Factor X deficiency as seen in amyloid purpura	Prolonged	Prolonged	Unaffected	Unaffected
Glanzmann's thrombasthenia	Unaffected	Unaffected	Prolonged	Unaffected
Bernard-Soulier syndrome	Unaffected	Unaffected	Prolonged	Decreased or unaffected
Factor XII deficiency	Unaffected	Prolonged	Unaffected	Unaffected
C1INH deficiency	Unaffected	Shortened	Unaffected	Unaffected

Causes other than coagulation [edit]

Bleeding diathesis may also be caused by impaired wound healing (as in scurvy), or by thinning of the skin, such as in Cushing's syndrome .

References [edit]

^ ^a ^b ^c ^d ^e Wiskott-Aldrich Syndrome The International Patient Organisation for Primary Immunodeficiencies (IPOPI).
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Disorders of thrombosis and hemostasis: clinical and laboratory practice. Page Rodger L. Bick. Edition 3, illustrated. ISBN 0-397-51690-8, ISBN 978-0-397-51690-2. 446 pages
^ ^a ^b ^c Vitamin K Deficiency eMedicine. Author: Pankaj Patel, MD. Coauthor(s): Mageda Mikhail, MD, Assistant Professor. Updated: Dec 18, 2008
^ ^a ^b ^c ^d Hemophilia Complications By Mayo Clinic staff. May 16, 2009
^ ^a ^b ^c ^d Von Willebrand disease --> Complications By Mayo Clinic staff. Feb. 7, 2009

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1. 出血性素因を有する成人患者へのアプローチ approach to the adult patient with a bleeding diathesis
2. 出血症状を有する小児に対するアプローチ approach to the child with bleeding symptoms
3. 婦人科外科手術における出血のマネージメント management of hemorrhage in gynecologic surgery
4. Crimean-Congo hemorrhagic fever
5. 妊娠していない生殖可能年齢の女性における不正子宮出血に対するアプローチ approach to abnormal uterine bleeding in nonpregnant reproductive age women

English Journal

Attenuated platelet aggregation in patients with septic shock is independent from the activity state of myosin light chain phosphorylation or a reduction in Rho kinase-dependent inhibition of myosin light chain phosphatase.

Reddi BA1, Iannella SM, O'Connor SN, Deane AM, Willoughby SR, Wilson DP.
Intensive care medicine experimental.Intensive Care Med Exp.2015 Dec;3(1):37. doi: 10.1186/s40635-014-0037-7. Epub 2015 Feb 12.
BACKGROUND: Impaired coagulation contributes to the morbidity and mortality associated with septic shock. Whether abnormal platelet contraction adds to the bleeding tendency is unknown. Platelets contract when Ca(2+)-dependent myosin light chain kinase (MLCK) phosphorylates Ser19 of myosin light cha
PMID 26215804

Clinical features and outcomes in 154 patients with haemorrhagic moyamoya disease: comparison of conservative treatment and surgical revascularization.

Huang Z, Ding X, Men W, Zhang D, Zhao Y, Wang R, Wang S, Zhao J.
Neurological research.Neurol Res.2015 Oct;37(10):886-92. doi: 10.1179/1743132815Y.0000000073. Epub 2015 Jul 9.
OBJECTIVES: Rebleeding is an unsatisfactory outcome for patients with haemorrhagic MMD. This study mainly investigated clinical features and outcomes in haemorrhagic MMD.METHODS: A retrospective review was performed on a total of 154 patients with haemorrhagic MMD comprising 126 surgically treated a
PMID 26159234

Desmopressin improves platelet function in uremic patients taking antiplatelet agents who require emergent invasive procedures.

Kim JH1, Baek CH, Min JY, Kim JS, Kim SB, Kim H.
Annals of hematology.Ann Hematol.2015 Sep;94(9):1457-61. doi: 10.1007/s00277-015-2384-1. Epub 2015 May 3.
Uremia is associated with platelet dysfunction and can cause a bleeding tendency resulting in a major bleeding event after an invasive procedure or surgery that may be aggravated by antiplatelet agents. We prospectively investigated the potential of desmopressin to improve platelet dysfunction and t
PMID 25933676

Japanese Journal

ANCA関連血管炎における選択的血漿交換の有用性及び安全性についての検討(<特集>アフェレシス技術の進歩・普及・教育)

眞屋佳子,山田康弘,森行範,明石好弘,瀬戸邦雄,倉田典之,大西郁子,猪尾昌之
日本アフェレシス学会雑誌 33(1), 26-30, 2014-02-28
… Moreover, as Selective PE can retain fibrinogen and can be performed with an albumin solution for replacement fluid, it may be a safe and effective treatment taking into consideration of the risk of infection or bleeding tendency. …
NAID 110009804252

Non-traumatic Ocular and Periocular Hemorrhages in a Hypertensive Patient under Continuous Ambulatory Peritoneal Dialysis and Warfarin Therapy

Yen Hung-Wen,Lau Ling-Ing,Yang Wu-Chang,Lin Pei-Yu,Shen Chia-Lin,Hu Fen-Hsiang,Lin Chih-Ching
Internal Medicine 53(20), 2337-2339, 2014
… The bleeding tendency caused by uremia and the use of warfarin during uncontrolled high blood pressure were most likely responsible for her ocular and periocular hemorrhages. … Appropriate control of blood pressure and adequate self-care education are important for the prevention and treatment of any bleeding complications in uremic patients receiving both maintenance anticoagulation therapy and peritoneal dialysis. …
NAID 130004699295

腹部鈍的外傷後の遅発性結腸穿孔の1例

真船太一,寺島秀夫,中野順隆,今村史人,間瀬憲多朗,神賀正博
日本臨床外科学会雑誌 75(3), 726-730, 2014
症例は抗凝固療法を受けていた80歳，女性．転倒後10日目に腹痛を主訴に当院受診．精査により血性腹水を認め，腫瘤性病変は結腸壁内血腫と推定された．保存的治療により全身状態は改善し，腹部症状も消失した．転倒後16日目に再度腹痛が出現し，腹部CT検査によって消化管穿孔による急性汎発性腹膜炎と診断し緊急手術を施行した．緊急手術の所見では横行結腸脾彎曲部の壁内血腫と穿孔を認め，結腸部分切除術と人工肛門造設術 …
NAID 130004696557

Related Pictures

★リンクテーブル★

リンク元	「出血傾向」「haemorrhagic diathesis」
関連記事	「tendency」

「出血傾向」

Bleeding diathesis
	Classification and external resources
ICD-10	D69.9
ICD-9	287.9
DiseasesDB	1442
MeSH	D006474

　　[★]

英: bleeding tendency
同: 出血性素因(出血素因、出血性素質) hemorrhagic diathesis
関: 血小板、凝固系、線溶系、出血傾向、血友病。出血性疾患

一次止血障害

血小板数の減少　→　出血時間↑
血小板機能異常　→　出血時間↑
血管壁の異常　　→　血管抵抗性試験悪化

二次止血障害

凝固異常　　　　→　凝固時間↑
線溶亢進　　　　→　凝固時間↑

出血傾向と症状

	血小板・血管壁の異常	凝固異常	線溶異常
出血部位	体表部(皮膚・粘膜)	深部(皮下・筋肉・関節)	深部組織に多い
出血徴候	点状出血・小斑状出血	大斑状出血・後出血	後出血・漏出性出血
特徴	小さな傷でも出血するが圧迫で容易に止血しやすい	じわじわ出血がすすみ、局所止血で止まりにくい	一旦出血が止まった後に再出血する

出血部位による鑑別診断

出血症状	血小板、血管壁の異常	凝固因子の異常
点状出血	誘発する	少ない
粘膜出血	誘因なしに見られる	機械的刺激、外傷の後に見られることが多い
筋肉・関節内出血	基本的になし	特徴的
外傷、手術後の出血	直後から見られる	しばらくたってから見られる。