Bruising and bleeding

The aim of this topic is to review the pathophysiology and investigation of common bleeding problems, and to discuss the complications of blood transfusions.

Learning objectives:

At the completion of this topic you should be able to:

1. Describe the structure and function of platelets, and their role in haemostasis.
2. Compare and contrast the intrinsic and extrinsic coagulation pathways, and the investigations used to assess them.
3. Describe the common congenital and acquired causes of bleeding disorders, and their typical clinical presentations.
4. Outline the genetics and pathophysiology of the haemophilias and Von Willebrand disease.
5. Summarise the common causes of thrombocytopaenia. In particular, outline the pathophysiology of idiopathic thrombocytopaenic purpura, disseminated intravascular coagulation and infiltrative disease of the bone marrow.
6. Outline the laboratory evaluation of a patient with thrombocytopaenia, disseminated intravascular coagulation, and bleeding associated with liver disease.
7. List the indications for blood and platelet transfusions.
8. Outline the basic principles and techniques of cross-matching whole blood prior to transfusion.
9. Describe the main complications of blood, white cell and platelet transfusions, and the pathophysiology of these reactions.

1. Briefly outline the pathogenetic mechanisms of the common complications of blood transfusions.
2. Outline an appropriate sequence of investigations to determine the cause of spontaneous bruising and recurrent epistaxis.

Case protocol associated with this topic - 8

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