Some Causes of Excessive Bleeding
Category | Examples |
|---|---|
Platelet disorders | |
Decreased number of platelets (quantitative disorder) | Inadequate production (eg, in leukemias, aplastic anemia, and some myelodysplastic syndromes) Decreased production due to thrombopoietin deficiency related to liver disease Splenic sequestration (eg, in cirrhosis with congestive splenomegaly) Increased platelet destruction or consumption (eg, in immune thrombocytopenia [ITP], DIC, thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, sepsis, and HIV infection) Medication-induced destruction (eg, by heparin |
Increased number of platelets (quantitative disorder) | Essential thrombocythemia (bleeding may occur with very high platelet counts) |
Inadequate platelet function (qualitative disorder) | Von Willebrand disease (inadequate VWF-mediated platelet adhesion) Medication-induced dysfunction (eg, by aspirin Systemic disorders (uremia; occasionally, myeloproliferative disorders [due to platelet destruction of VWF at very high platelet counts], myelodysplastic syndromes, multiple myeloma) |
Coagulation disorders | |
Acquired | Liver disease Anticoagulation with warfarin, heparin or the direct oral inhibitors of thrombin or factor Xa DIC |
Hereditary | Hemophilia A (factor VIII deficiency) Hemophilia B (factor IX deficiency) |
Vascular disorders | |
Acquired | |
Hereditary | Connective tissue disorders (eg, Ehlers-Danlos syndrome, osteogenesis imperfecta, Marfan syndrome) |
DIC = disseminated intravascular coagulation; NSAIDs = nonsteroidal anti-inflammatory drugs; VWF =von Willebrand factor. | |