Bleeding Tendency: Or something else? Differential Diagnosis

Blood, hematopoietic organs-immune system (D50-D90).

  • Bleeding tendency (uremic) – bleeding time prolonged by uremia (occurrence of urinary substances in the blood above normal values).
  • Coagulation defects:
    • Disseminated Intravascular Coagulation (DIC) – acquired life-threatening condition in which clotting factors are depleted in the vasculature due to excessive blood clotting, resulting in a bleeding tendency.
    • Liver failure
    • Hemophilia A, B
    • Willebrand-Jürgens syndrome
    • Vitamin K deficiency
    • Bleeding tendency due to factor deficiency, unspecified
  • Purpura, senile – in old age occurring small-spotted capillary bleeding in the skin on light-exposed body parts (back of the hand and forearm).
  • Schönlein-Henoch purpura [new: IgA vasculitis (IgAV)] (synonyms: Anaphylactoid purpura; Acute infantile hemorrhagic edema; Schönlein-Henoch disease; Purpura anaphylactoides; Purpura anaphylactoides; Purpura Schönlein-Henoch (PSH); Seidlmayer cocard purpura; Schönlein-Henoch purpura; Vasculitis allergica; D69. 0) – immunologically mediated vasculitis (vascular inflammation) of the capillaries and pre-capillary and post-capillary vessels, which usually runs without complications; as a multisystem disease, it preferentially affects the skin, joints, intestines and kidneys.
  • Scurvy
  • Thrombocytopenia (platelets < 150,000/μl):
    • Synthesis disorders – aplastic disorders: Fanconi syndrome; bone marrow damage (chemicals – eg, benzene -, infections (eg, HIV); cytostatic therapy, radiation therapy).
    • Bone marrow infiltrations (leukemias/blood cancers, lymphomas, bone marrow metastases).
    • Maturation disorders (e.g. megaloblastic anemia/pernicious anemia).
    • Increased peripheral turnover of platelets (thrombocytes).
      • Disseminated intravascular coagulation; disseminated intravascular coagulation (DIC syndrome, for short; consumption coagulopathy).
      • Idiopathic thrombocytopenic purpura (ITP; Werlhof’s disease) – autoantibody-mediated disorder of platelets; incidence: 1-4%.
      • Hemolytic uremic syndrome (HUS) – triad of microangiopathic hemolytic anemia (MAHA; form of anemia in which erythrocytes (red blood cells) are destroyed), thrombocytopenia (abnormal reduction of platelets), and acute kidney injury (AKI); usually occurring in children in the setting of infections; most common cause of acute renal failure requiring dialysis in childhood.
      • Hypersplenism – complication of splenomegaly; leads to an increase in functional capacity beyond what is necessary; as a result, there is excessive elimination of erythrocytes (red blood cells), leukocytes (white blood cells) and platelets (platelets) from the peripheral blood, resulting in pancytopenia (synonym: tricytopenia; reduction of all three cell series in the blood).
      • Systemic lupus erythematosus (SLE).
    • Gestational thrombocytopenia (isolated thrombocytopenia); Manifestation: II./III. Trimester / third trimester; course: asymptomatic; frequency: 75%; affects about 5-8% of all pregnancies.
    • HELLP syndrome (H = hemolysis, EL = elevated liver enzymes, LP = low platelets (thrombocytopenia)) – special form of preeclampsia associated with blood count changes; frequency: 15-22 %.
    • Spontaneous bleeding, unspecified drug-induced.
    • Thrombotic thrombocytopenic purpura (TTP; synonym: Moschcowitz syndrome) – acute onset purpura with fever, renal insufficiency (kidney weakness; renal failure), anemia (anemia), and transient neurologic and mental disorders; occurrence largely sporadic, autosomal dominant in familial form
    • Thrombocytopenia (due to medication; see below).
  • Thrombocytopathy (platelet dysfunction):
    • Congenital platelet defects: e.g., Glanzmann thrombasthenia, Bernard-Soulier syndrome.
    • Acquired platelet defects: Liver cirrhosis, monoclonal gammopathy, myeloproliferative disorders, uremia, and by antiplatelet therapy.
  • Willebrand-Jürgens syndrome (synonyms: von Willebrand-Jürgens syndrome; von Willebrand syndrome, vWS) – most common congenital disease with increased bleeding tendency; disease is predominantly transmitted autosomal-dominantly with variable penetrance, type 2 C and type 3 are inherited autosomal-recessively; there is a quantitative or qualitative defect of the von Willebrand factor; this impairs, among others. Among other things, the platelet aggregation (aggregation of platelets) and their cross-linking and / or (depending on the manifestation of the disease) the degradation of coagulation factor VIII is insufficiently inhibited.

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Cushing’s disease (facial plethora) – group of disorders leading to hypercortisolism (hypercortisolism; excess of cortisol).
  • Wilson’s disease (copper storage disease) – autosomal recessive inherited disease in which copper metabolism in the liver is disturbed by one or more gene mutations.

Skin and subcutaneous (L00-L99).

  • Nevus fuscocaeruleus: blue-green or blue-gray patchy accumulation of melanocytes expressed in varying size, shape, intensity, and localization (coccyx and buttocks); increase in size as well as intensity in the first year of life, spontaneous regression in the following years; by the age of five, 97% of the changes are no longer detectable; occurrence in central and northern European children in 1-10% of cases.

Infectious and parasitic diseases (A00-B99).

Liver, gallbladder, and biliary tract-pancreas (pancreas) (K70-K77; K80-K87).

Neoplasms – tumor diseases (C00-D48)

  • Leukemia (blood cancer
  • Hodgkin’s disease – malignant neoplasm (malignant neoplasm) of the lymphatic system with possible involvement of other organs.
  • Myelodysplastic syndrome (MDS) – acquired clonal disease of the bone marrow associated with a disorder of hematopoiesis (blood formation); defined by:
    • Dysplastic cells in the bone marrow or ring sideroblasts or an increase of myeloblasts up to 19%.
    • Cytopenias (decrease in the number of cells in the blood) in the peripheral blood count.
    • Exclusion of reactive causes of these cytopenias.

    One quarter of MDS patients develop acute myeloid leukemia (AML).

  • Non-Hodgkin’s lymphoma – all malignant (malignant) lymphomas other than Hodgkin’s lymphoma.

Psyche – nervous system (F00-F99; G00-G99).

  • Alcohol dependence

Pregnancy, childbirth and puerperium (O00-O99)

  • Gestational thrombocytopenia (isolated thrombocytopenia; decreased number of platelets (thrombocytes) during pregnancy); manifestation: II/3rd trimester. Trimester; course: asymptomatic; frequency: 75%; affects about 5-8% of all pregnancies.
  • HELLP syndrome (H = hemolysis, EL = elevated liver enzymes, LP = low platelets (thrombocytopenia)) – special form of preeclampsia, which is associated with blood count changes; frequency: 15-22 %.

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Uremia – occurrence of urinary substances in the blood above normal levels.

Injury, poisoning, and certain other sequelae of external causes (S00-T98).

  • Abuse of persons
  • Trauma (injuries)

Medications that can lead to an increased bleeding tendency (A claim to completeness does not exist! ):

Platelet dysfunction (A claim to completeness does not exist! ):

* Simultaneous use of anticoagulants and antibiotics leads to an increased risk of bleeding! Thrombocytopenia (lack of platelets; a claim to completeness does not exist! ):