Coagulopathies - classification, etiology, pathogenesis, and clinical manifestations
Coagulopathies are disorders of hemostasis characterized by defects in coagulation factors, platelets, or both, leading to abnormal bleeding or, less commonly, thrombosis.
Classification
- 1 By primary defect
- 2 By etiology
Etiology
- Hereditary causes
- Hemophilia A (X- linked, factor VIII deficiency).
- Hemophilia B (Christmas disease, factor IX deficiency).
- von Willebrand disease (deficiency or dysfunction of von Willebrand factor).
- Acquired causes
- Vitamin K deficiency:
- Malabsorption, biliary obstruction, prolonged antibiotic use.
- Liver failure:
- Reduced synthesis of most coagulation factors.
- DIC:
- Sepsis, severe trauma, malignancies, obstetric complications.
- Anticoagulant therapy:
- Warfarin, heparin (can also induce thrombocytopenia).
- Immune-mediated:
- Acquired inhibitors to clotting factors.
Clinical manifestations
- Coagulation factor deficiency (e.g., hemophilias )
- Deep tissue bleeding (muscles, joints —hemarthroses).
- Large, spreading hematomas.
- Delayed bleeding after trauma or surgery.
- Platelet defects
- Mucocutaneous bleeding (petechiae, purpura, ecchymoses).
- Epistaxis (nosebleeds).
- Gingival bleeding.
- Menorrhagia.
- Combined defects (DIC, liver failure)
- Widespread ecchymoses.
- Bleeding from venipuncture sites or surgical wounds.
- Organ dysfunction from microthrombi (DIC)