Evaluation of patients admitted to the hematology outpatient clinic for spontaneous ecchymosis: Does it suggest bleeding diathesis?

Yıl 2023, , 131 - 136, 27.09.2023

Seda Yılmaz , Rafiye Ciftciler , Mikail Dağ

https://doi.org/10.47482/acmr.1277981

Öz

Background: Spontaneous ecchymosis is a common reason for referral to the hematology outpatient clinic. It is important to determine whether the underlying bleeding is benign or a symptom of diathesis.
Methods: The sample of this retrospective study consisted of 119 patients with normal platelet counts who presented to the adult hematology outpatient clinic with spontaneous ecchymosis between September 2021 and August 2022. The site of the ecchymosis, patients’ familial and bleeding histories, and the drugs they have been using were queried. Hemogram and coagulation parameters and peripheral smear findings of the patients were recorded, and their ISTH-SSC (International Society on Thrombosis and Haemostasis Scientific and Standardization Committee) Bleeding Assessment Tool scores were calculated.
Results: The median age of the patients, of whom 113 (95%) were female and 6 (5%) were male, was 30 (18-85) years. The ecchymosis was in the extremities and the trunk in 110 (92.4%) and 9 (7.6%) patients, respectively. There was no significant difference between the patients with and without bleeding history in terms of the site of spontaneous ecchymosis, the hemogram parameters and peripheral smear findings. Similarly, the patients with and without factor deficiency have not differed significantly in terms of hemogram parameters and peripheral smear findings. Patients with any factor deficiency had significantly higher ISTH-SSC Bleeding Assessment Tool scores compared to the patients without factor deficiency.
Conclusion: The findings of the study revealed that the site of ecchymosis and hemogram and coagulation parameters cannot be used as markers in the general sense, except for the ISTH-SSC Bleeding Assessment Tool scores, which predicted factor deficiency. Another finding of the study worth mentioning is the fact that number of patients with ecchymosis on the trunk among the patients presenting with the complaint of ecchymosis was significantly lower than that of patients with ecchymosis on the extremities.

Anahtar Kelimeler

Ecchymosis, factor deficiency, platelet

Destekleyen Kurum

NONE

Kaynakça

• Valente MJ, Abramson N. Easy bruisability. South Med J. 2006;99(4):366- 70.
• Mauer AC, Khazanov NA, Levenkova N, Tian S, Barbour EM, et al. Impact of sex, age, race, ethnicity and aspirin use on bleeding symptoms in healthy adults. J Thromb Haemost. 2011;9(1):100-8.
• Wahlberg T, Blombäck M, Hall P, Axelsson G. Application of indicators, predictors and diagnostic indices in coagulation disorders. I. Evaluation of a self-administered questionnaire with binary questions. Methods Inf Med. 1980;19(4):194-200.
• Srámek A, Eikenboom JC, Briët E, Vandenbroucke JP, Rosendaal FR. Usefulness of patient interview in bleeding disorders. Arch Intern Med. 1995;155(13):1409-15.
• Garvey B. Easy bruising in women. Can Fam Physician. 1984 Sep;30:1841-4.
• Yonashiro-Cho JMF, Gassoumis ZD, Wilber KH, Homeier DC. Improving forensics: Characterizing injuries among community-dwelling physically abused older adults. J Am Geriatr Soc. 2021;69(8):2252-2261.
• Harrison, LB, Nash MJ, Fitzmaurice D, Thachil J. Investigating easy bruising in an adult. BMJ. 2017;356:j251.
• James PD. Women and bleeding disorders: diagnostic challenges. Hematology Am Soc Hematol Educ Program. 2020;2020(1):547-552.
• Warner PE, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray GD. Menorrhagia II: is the 80-mL blood loss criterion useful in management of complaint of menorrhagia? Am J Obstet Gynecol. 2004;190(5):1224-1229.
• Sadler JE, Mannucci PM, Berntorp E, Bochkov N, Boulyjenkov V, Ginsburg D, et al. Impact, diagnosis and treatment of von Willebrand disease. Thromb Haemost. 2000;84(2):160-174.
• van Galen KPM, d’Oiron R, James P, Abdul-Kadir R, Kouides PA, Kulkarni R, et al. A new hemophilia carrier nomenclature to define hemophilia in women and girls: communication from the SSC of the ISTH. J Thromb Haemost. 2021;19(8):1883-1887.
• Tosetto A, Rodeghiero F, Castaman G, Goodeve A, Federici AB, Batlle J, et al. A quantitative analysis of bleeding symptoms in type 1 von Willebrand disease: results from a multicenter European study (MCMDM-1 VWD). J Thromb Haemost. 2006; 4(4):766-773.
• Bowman M, Mundell G, Grabell J, Hopman WM, Rapson D, Lillicrap D, et al. Generation and validation of the Condensed MCMDM-1VWD Bleeding Questionnaire for von Willebrand disease. J Thromb Haemost. 2008;6(12):2062-2066.
• Rodeghiero F, Tosetto A, Abshire T, Arnold DM, Coller B, James P, et al. ISTH/SSC joint VWF and Perinatal/Pediatric Hemostasis Subcommittees Working Group. ISTH/ SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders. J Thromb Haemost. 2010;8(9):2063-2065.
• Deforest M, Grabell J, Albert S, Young J, Tuttle A, Hopman WM, et al. Generation and optimization of the self-administered bleeding assessment tool and its validation as a screening test for von Willebrand disease. Haemophilia. 2015;21(5): e384-e388.
• Elbatarny M, Mollah S, Grabell J, Bae S, Deforest M, Tuttle A, et al. Zimmerman Program Investigators. Normal range of bleeding scores for the ISTH-BAT: adult and pediatric data from the merging project. Haemophilia. 2014;20(6):831-83.
• Flood VH, Christopherson PA, Gill JC, Friedman KD, Haberichter SL, Bellissimo DB, et al. Clinical and laboratory variability in a cohort of patients diagnosed with type 1 VWD in the United States. Blood. 2016;127(20):2481-2488.
• Lavin M, Aguila S, Schneppenheim S, Dalton N, Jones KL, O’Sullivan JM, et al. Novel insights into the clinical phenotype and pathophysiology underlying low VWF levels. Blood. 2017; 130(21):2344-2353.