The physiology of hemostasis Nobuyuki KATORI 1 1Department of Anesthesiology Jikei University School of Medicine pp.183-188
Published Date 2020/1/1
DOI https://doi.org/10.11477/mf.3102200724
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Bleeding tendencies or bleeding diatheses present as spontaneous internal or mucocutaneous bleeding without a specific cause such as trauma or surgery. Although the causes of bleeding tendencies are multifactorial, three factors play a major role in the pathogenesis of bleeding tendencies, alone or in combination:abnormalities in vessel walls, thrombocytopenia and/or platelet dysfunction, and deficiencies or dysfunction of coagulation factors or fibrinolytic factors. Although the clinical manifestations of bleeding tendencies depend on the underlying cause in each patient, there are four major symptoms of bleeding tendencies including purpura such as petechia, mucosal bleeding such as gingival or gastrointestinal bleeding, bleeding in soft tissues or organs such as intracranial or intramuscular hemorrhage, and recurrent bleeding after hemostasis. Typical symptoms in patients with vessel wall abnormalities or thrombocytopenia/platelet dysfunction are mucocutaneous bleeding such as petechiae, ecchymoses and nose or gingival bleeding, although bleeding into muscles or joints is rare. Hemarthroses or hematomas in soft tissues are typical symptoms in patients with coagulation factor deficiencies because thrombin production and subsequent fibrin formation are impaired, which is usually more severe than in patients with vessel wall abnormalities or thrombocytopenia/platelet dysfunction. In addition to these major causes, comorbidities such as atherosclerosis, hypertension, or gastric ulcers may increase bleeding risks especially in the elderly. It is important to evaluate both overt and concomitant bleeding risks.

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