Girolami A, Luzzatto G, Varvarikis C, Pellati D, Sartori R, Girolami B
Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy.
Haemophilia. 2005 May;11(3):193-202. doi: 10.1111/j.1365-2516.2005.01100.x.
A suitable clinical evaluation of a bleeding diathesis is often forgone. The young doctor is often unprepared to describe in an accurate way the different types of bleeding. An adequate classification and adequate clinical information about a bleeding diathesis are instead of paramount importance. Bleeding may be cutaneous, mucous, articular, muscular, parenchymal, intracavitary, orificial. Each of these sites and forms may have diagnostic implications. An accurate description of the several forms of cutaneous bleeding (petechiae, purpuric spots, ecchymosis, haematomas, etc.) is needed for referrals and for controls. The correct evaluation of cutaneous bleeding manifestations of children (battered child syndrome) is absolutely important for clinical and medico-legal purposes. The same is true for the battering syndrome seen in women abused by their spouses. The grading of haemarthrosis in haemophilia patients is important for the follow-up. A proper description of haematuria is essential in suggesting the probable site of bleeding (kidney or bladder or urethra). A proper evaluation of bleeding may give also useful information on the general health status of the patients (presence of anaemia, poor nutrition, renal insufficiency, etc.). The combination of bleeding and thrombosis in the same patient is also a clinical challenge. The relationship between haemorrhage and thrombosis may be sequential or concomitant. Sequential thrombosis may occur in a patient confined in bed for a brain haemorrhage. Concomitant thrombosis and bleeding occur in DIC and in patients with thrombosis being treated with anticoagulants. Finally, it should be kept in mind that a proper evaluation of the bleeding diathesis of a given patient may help the caring doctor in ordering appropriate laboratory tests (e.g. a platelet count for petechiae, a PTT for a patient with haemarthrosis, etc.).
对出血性素质进行恰当的临床评估常常被忽视。年轻医生往往没有准备好准确描述不同类型的出血。然而，对出血性素质进行充分的分类和提供足够的临床信息至关重要。出血可能是皮肤性、黏膜性、关节性、肌肉性、实质性、腔内性、口部性的。这些部位和形式中的每一种都可能具有诊断意义。为了转诊和对照，需要准确描述几种皮肤出血形式（瘀点、紫癜、瘀斑、血肿等）。正确评估儿童的皮肤出血表现（受虐儿童综合征）对于临床和法医学目的绝对重要。对于遭受配偶虐待的女性中出现的殴打综合征也是如此。血友病患者关节积血的分级对于随访很重要。正确描述血尿对于提示可能的出血部位（肾脏、膀胱或尿道）至关重要。对出血进行恰当评估还可能提供有关患者总体健康状况的有用信息（贫血、营养不良、肾功能不全等情况）。同一患者出现出血和血栓形成也是一个临床挑战。出血与血栓形成之间的关系可能是相继的或同时存在的。相继性血栓形成可能发生在因脑出血而卧床的患者中。同时存在血栓形成和出血见于弥散性血管内凝血以及正在接受抗凝治疗的血栓形成患者。最后，应该记住，对特定患者的出血性素质进行恰当评估可能有助于负责的医生开出合适的实验室检查（例如，对于瘀点进行血小板计数，对于关节积血患者进行部分凝血活酶时间测定等）。
