Diagnosis and Management of Acquired Bleeding Disorders

The hemostatic response to vascular injury consists of vascular constriction, platelet activation resulting in platelet adhesion (mediated by von Willebrand factor), and platelet aggregation resulting in an initial platelet plug formation at the site of vascular injury. This platelet plug is stabilized by formation of fibrin, which results from activation of the procoagulant coagulation factors. Congenital or acquired abnormalities of the procoagulant factors result in a bleeding and thrombotic tendency of variable severity. Acquired abnormalities of the procoagulant system are typically associated underlying systemic disorders; however, they may also be idiopathic. Recognition, laboratory diagnosis, and principles of management of acquired coagulopathy are reviewed in this chapter.