Spontaneous bleeding

O Intravenous factor replacement with recombinant or plasma-derived products to treat or prevent bleeding is the primary treatment hemophilia. Primary prophylaxis is defined as the regular administration of factor concentrates with the intention of preventing joint bleeds.4 The rationale for primary prophylaxis is that individuals with factor levels of greater than 0.02 unit/mL (2 IU/dL) rarely suffer from spontaneous bleeds and arthropathy. Therefore, to maintain a trough level above this might convert severe hemophilia to moderate disease, with the abolition of joint bleeds and the associated arthropathy.5... 

Factor Vila (rFVIIa) is a bypassing agent designed to generate thrombin only at tissue injury sites, where it binds tissue factor and, in this manner, minimizes the risk of systemic thrombotic events. rFVIIa is used effectively in surgeries and spontaneous bleeds.14... 

Factor Deficient Major Surgery Spontaneous Bleeding... 

The product displays a mean serum half-life of 18.8 h in humans. It has been evaluated in four clinical trials involving a total of 128 subjects and in the context of both spontaneous bleeding and surgery. Some 88 per cent of the total infusions administered for bleeding were rated as providing a good or excellent response. Reported side effects, although uncommon, included hypersensitivity, as well as headache, fever and nausea. BeneFix is marketed by Wyeth. 

Hemophilia There have been reports of spontaneous bleeding in patients with hemophilia A and B treated with protease inhibitors. In some patients, additional Factor VIII was required. 

Indications Control and prevention of hemorrhagic episodes and for surgical prophylaxis in patients with hemophilia A. Short-term routine prophylaxis to reduce the frequency of spontaneous bleeding episodes (ReThcto). Prevention and control of hemorrhagic episodes in hemophilia A perioperative management of patients with hemophilia A (Recombinate). 

Whether PI agents are associated with bone loss and osteoporosis after long-term use is controversial and under active investigation. Pis have been associated with increased spontaneous bleeding in patients with hemophilia A or B. 

S., and Degen, J. L. (1995). Resolution of spontaneous bleeding events but failure of pregnancy in fibrinogen-deficient mice. Genes Develop. 9, 2020-2033. 

Bent S, Goldberg H, Padula A, Avins AL. Spontaneous bleeding associated with ginkgo biloba-. a case report and systematic review of the literature a case report and systematic review of the literature. J Gen Intern Med. 2005 20 657-661. 

Excessive bleeding and thrombosis may represent altered states of hemostasis. Impaired hemostasis results in spontaneous bleeding stimulated hemostasis results in thrombus formation. The drugs used to arrest abnormal bleeding and to inhibit thrombosis are the subjects of this chapter. 

Mild phenotype compared with severe hemophilia A in humans no spontaneous bleeding, illness or reduced activity during the first year of life have residual clotting activity (APTT) as shown by Bi et al. (1995). 

Mice are viable, fertile, appear normal do not suffer spontaneous bleeding or thrombosis have normal tail bleeding time. Platelets fail to aggregate irreversibly to ADP, collagen, or U 46619. Arterial and venous thrombosis is inhibited and mice are protected from fatal thromboembolism after injection of collagen plus epinephrine (Angelillo-Scherrer et al. 2001). 

Viable, fertile, increased fetal mortality features of Glanzmann thrombasthenia in man, e.g. defective platelet aggregation, clot retraction, spontaneous bleeding, prolonged bleeding times dysfunctional osteoclasts, development of osteosclerosis with age (Hodivala-Dilke et al. 1999 McHugh et al. 2000). 

Factor VIII levels strongly reduced due to defective protection by vWF highly prolonged bleeding time, hemorrhage, spontaneous bleeding mice useful for investigating the role of vWF delayed platelet adhesion in ferric-chloride-induced arteriolar injury (Denis et al. 1998 Ni et al. 2000). 

A 63-year-old woman taking acenocoumarol 18 mg/ week (INR 1.8) started to take citalopram 20 mg/day and 10 days later noted spontaneous bleeding from her gums the INR had risen to more than 15 (31). She was treated with two units of whole blood and the citalopram was withdrawn. Five days later the INR had returned to the target range. 

Low-dose unfractionated heparin or LMW heparin can be used to prevent venous thromboembolism in other high-risk patients, e.g. those confined to bed and immobilised with strokes, cardiac failure or malignant disease. Spontaneous bleeding has not been a problem with this form of anticoagulant treatment. 

Primary prophylaxis with factor VIII three times weekly or factor IX concentrate twice weekly at doses to keep the factor level above 1-2% beginning in toddlers (through an indwelling venous cannula) results in a significant reduction in spontaneous bleeds and arthropathy. 

Diclofenac can cause panmyelopathy (8). Data from the International Agranulocytosis and Aplastic Anemia Study showed an increased risk of aplastic anemia (multivariate rate-ratio 8.8) (9). Fatal aplastic anemia has also been described (SEDA-4, 69) (10), as have purpura and thrombocytopenia, although not always with certainty. Spontaneous bleeding (subcutaneous bruises, hematoma, greater wound drainage) has been associated with diclofenac (SEDA-15,100). 

Thrombophlebitis at the infusion site is a common complication of continuous infusion of various clotting factor concentrates and has been noted after infusion of factor Vila (9,10). Thrombophlebitis occurred in one of eight hemophiliacs with inhibitors who received continuous infusion of recombinant factor Vila to allow elective surgery (11). In 25 hemophilia patients with inhibitors, who received recombinant factor Vila for surgical procedures or spontaneous bleeding, there was one case of thrombophlebitis in 35 continuous infusion courses (12). In most instances, thrombophlebitis can be prevented by parallel infusion of saline or heparin. 

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