Spontaneous haemorrhage

Occurrence of spontaneous haemorrhage Types of treatment given (i) (ii) (iii) 

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Heparin, which has an anticoagulation action, may give rise to heparin-induced thrombocytopenia, which is an immune-mediated condition that usually develops 5-10 days after the administration of the drug. When heparin is used, a platelet count should be measured before treatment and if administration is repeated, platelet counts should be monitored regularly. Signs of thrombocytopenia include a reduction in platelet count. It may present with spontaneous haemorrhage and heparin should be stopped. Factor VIII is used in the treatment and prophylaxis of haemorrhage in patients with haemophilia. 

If no haemorrhagic diathesis is present or when no invasive measures or techniques which might possibly distress the patient are planned, coagulation disorders generally require no treatment. The equilibrium between haemostasis and fibrinolysis, which is based on lower clotting factor levels, is indeed somewhat unstable, yet it does not normally lead to spontaneous haemorrhaging. 

Table 3.5. Production of spontaneous haemorrhage Types of treatmerU...

Mortality of 30-100 per cent from spontaneous haemorrhage " = Mortality < 20 per cent (usually < i per cent) from spontaneous haemorrhage... 

Mast H, Youg WL, Koennecke HC et al. (1997) Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet 350 1065-1068... 

Haemophilia is characterised by repeated, spontaneous and traumatic haemorrhages. It is divided into two classes, haemophilia A and haemophilia B. 

Differential diagnosis of spontaneous and traumatic intracranial haemorrhage. Journal of Neurology, Neurosurgery and Psychiatry 54 1118... 

Spontaneous haemostasis Some 60-80% of all upper gastrointestinal haemorrhages cease spontaneously. Early diagnosis with simultaneous stabilization of the circulation facilitates such spontaneous haemostasis without further therapeutic measures being called for. In 10-15% of cases, the bleeding persists. 

A possible spontaneous haemostasis, which is found without active therapy in about half the cases of upper gastrointestinal bleeding, should on no account encourage the assumption of a passive approach with the postponement of suitable therapeutic procedures. There is an enormous danger of massive renewed haemorrhage as well as of the development of complications within a few hours following spontaneous haemostasis, (s. fig. 19.12)... 

Vinall PS, Jenkins DM. Salbutamol and haemorrhage at spontaneous abortion. Lancet 1977 2(8052-8053) 1355. 

Buxton N, Flannery T, Wild D, Bassi S. Sildenafil (Viagra)-induced spontaneous intracerebral haemorrhage. Br J Neurosurg 2001 15(4) 347-9. 

Nevertheless, a 63-year-old patient who had just started acenocoumarol 18 mg per week developed spontaneous gingival haemorrhage 10 days after also starting eitalopram 20 mg daily for depression. Her INR had increased from a value of 1.8 to greater than 15. She was treated with... 

A search of Health Canada s database of spontaneous adverse reactions for the period January 1999 to June 2003 found 21 reports of suspected adverse reactions associated with ginkgo. Most of these involved platelet, bleeding and clotting disorders. One report of a fatal gastrointestinal haemorrhage was associated with ticlopidine and ginkgo, both taken over... 

Purroy Garcia, E, C. Molina, and J. Alvarez Sabia 2002. Spontaneous cerebellar haemorrhage associated with Ginkgo biloba ingestion. Med. Clin. 119(15) 596-597. 

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