Abstract
Acquired bleeding disorders (ABD) are commonly encountered in both inpatient and outpatient
settings. ABD can occur due to consumption, decreased synthesis, or inhibition of
coagulation factors and platelets. Clinical presentation may vary, ranging from mild
bruising to life-threatening hemorrhage. The location, frequency, severity, and provocation
of bleeding provide insight into the cause of ABD. Obtaining a good medical, surgical,
family, social, and medication history is a crucial step in determining the underlying
etiology. Basic laboratory parameters, such as prothrombin time, partial thromboplastin
time, thrombin time, fibrinogen, platelet count, and D-dimer levels, aid in further
elucidating the reason for bleeding. Optimal management depends on accurate interpretation
of the history and laboratory values. Treatment options include administration of
vitamin K; blood component transfusion, consisting of plasma, cryoprecipitate, and/or
platelets; and blood derivatives, including single and multiple factor concentrates.
These products should be used judiciously, due to potential infectious and noninfectious
complications, including transfusion-related acute lung injury and transfusion-associated
circulatory overload. This article discusses the management of the more common causes
of ABD.
Keywords
acquired coagulopathy - disseminated intravascular coagulation - liver disease - warfarin
reversal - new oral anticoagulants
