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Пульмонология, гематология (англ,рус)




 Prepared by Orlovsky A. V., assistant, D.Ph.,

                    Murenets N. A., postgraduate








Methodological Instruction to Lesson № 10.


Bleeding Disorder (Hemorrhagic diathesis)

Hours: 5.

Working place: classroom, hospital wards.




1. To give definition of the term “Hemorrhagic diathesis” (HD).

2. Classification of HD.

3. Homeostasis system and it physiology.

4. Types of a bleeding at HD.

5. Diagnostic criteria of Hemophilia.

6. Treatment and preventive maintenance of Hemophilia.

7. Diagnostic criteria of Willebrand's Disease.

8. Diagnostic criteria of Thrombocytopenic purpura.

9. Treatment of Werlhof’s disease.

10. Diagnostic criteria of Thrombocytopathy and Glanzmann's disease.

11. Variants of hemorrhagic vasculitis and  clinic depending on variant of illness.

12. Differential diagnostics of  hemorrhagic vasculitis.

13. Diagnostic criteria of Rendu-Osler-Weber Syndrome.


Examples of tests


1. The hemorrhagic diathesis which are caused by changes of abnormal blood vessels is all but one:

    a. Henoch-Schönlein Purpura                 d. Hemorrhagic vasculitis

    b. Rendu-Osler-Weber Syndrome           e. Willebrand's Disease

    c. Hemangioma


2. The hematomic type of hemorrhagic is at:

    a. Hemorrhagic vasculitis                      d. Hemophilia

    b. Werlhof’s disease                              e. Glanzmann's disease   

    c. Hemorrhagic telangiectasia


3. The petechialic type of hemorrhagic is at:

    a. Thrombocytopenic and thrombocytopathy                  d. Hemophilia

    b. Rendu-Osler-Weber Syndrome                                    e. Werlhof’s disease   

    c. Hemorrhagic vasculitis  


4. The patient 35 years during 5 years has nasal bleeding, ecchymosis on a skin. Two weeks back after nasal of a bleeding there was a weakness, faint. The patient has pallor, ecchymosis on a skin. The analysis of blood: er. – 4.2*1012/l, Hb – 90 g/l, chromatic parameter – 0.7, L. – 6.4* 109/l, stab n.- 3%, seg. – 67%, e. – 2%, l. – 23%, m – 5%, thrombocytes – 10*109/l , ESR – 15mm/ hour. With is diagnosis at the patient?

     a. Aplastic anemia                                   d. Iron deficiency Anemias      

     b. Hemorrhagic vasculitis                        e. Thrombocytopenic purpura   

     c. Hemophilia




4.     Davidson’s Principles and practice of medicine (nineteenth         edition)/Christopher Haslett, Edvin R. Chilvers and others. – Edinburgh, 2002.

5.     Harrisons Principle if internal medicine (seventeenth Edition)/Fauci, Braunwald, Hasper and other. – Part 6, section 2, Chapter 109, 110.

6.     The Merck Manual of Diagnosis and Therapy (seventeenth Edition)/ Robert Berkow, Andrew J. Fletcher and others. – published by Merck Research Laboratories, 1999.



Short theoretic material


Classification of hemorrhagic diathesis

Thrombocytopenia and platelet dysfunction:

·        Idiopatic thrombocytopenic purpura (ITP);

·        Thrombocytopenia other causes;

·        Thrombocytopenia due splenic sequestration;

·        Thrombotic thrombocytopenic purpura (TTP);

·        Hemolitic uremic syndrom (HUS);

·        Hereditary disorders of platelet function

Coagulation disorders:

·        Circulating anticoagulants;

·        Disseminated intravascular coagulation (DIC);

·        Hemophilia;

·        Uncomon hereditary coagulation disorders

     Bleeding due to abnormal blood vessels:

·        Autoerythrocyte sensitization;

·        Disprteinemias causing vascular purpura;

·        Hereditary hemorrhagic teleangiectasia;

·        Purpura simplex;

·        Senile purpura


·        Unusual or excessive bleeding includes unexplained nosebleeds (epistaxis), excessive or prolonged menstrual blood loss (menorrhagia), prolonged bleeding after minor cuts or trauma, easy bruising into tissues (ecchymoses) or skin (petechial or purpuric lesions), and unexplained gingival bleeding after tooth brushing;

·        Systemic bleeding can result from defects in blood vessels (connective tissue diseases, vitamin C deficiency, hereditary hemorrhagic telangiectasia) or, more commonly, quantitative or qualitative disorders of platelets  or of coagulation.



Etiology and Pathophysiology of Thrombocytopenia

·        Platelets are cell fragments that function in the clotting system. Thrombopoietin, primarily produced in the liver in response to decreased numbers of marrow megakaryocytes and circulating platelets, stimulates the bone marrow to synthesize platelets from megakaryocytes. Platelets circulate for 7 to 10 days. About 1⁄3 are always transiently sequestered in the spleen. red in the spleen. The platelet count is normally 140,000 to 440,000/μL.