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Signature ✍️
- Platelet defects: mucocutaneous bleeding (e.g. epistaxis, menorrhagia), often occurring immediately after trauma
- Coagulation cascade defects: hemarthrosis & deep space bleeding (e.g. hemothorax, retroperitoneal hematoma), often delayed/recurrent
- Vasculitis: ⊕ inflammatory markers, palpable purpura, end-organ damage
- Vasculopathy: “organs exploding,” out-of-proportion post-traumatic hemorrhage (e.g. ankle bump → large hematoma)
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DDx 🏳️🌈
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- Platelet disorders: quantitative defects (thrombocytopenia DDx)
- Clotting factor defects: prolonged clotting time DDx
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- Think again: mild factor deficiency below sensitivity of PT & PTT tests?
- Platelet disorders: qualitative defects (adhesion vs. aggregation vs. secretion)
- ↓ Clot stabilization: Factor 13 deficiency (”fibrin stabilizing factor”)
- Hyperfibrinolysis (acquired): APML (”coag-⊖ DIC”)
- Hyperfibrinolysis (congenital): ↓ alpha-2 antiplasmin, ↓ PAI-1, ↓ TAFI
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- Focal (Image ⊕)
- Vascular: AVF (often 2/2 chronic DVT), aneurysm, venous varix
- Neoplasm: vascular tumors (e.g. angiosarcoma, Kaposi)
- Early: … presentation of diffuse vasculopathy (i.e. see below)
- Diffuse (Image ⊖)
- Vasculitis DDx
- Vasculopathy DDx
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Principles❗️
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