Sarnaik Amit, Kamat Deepak, Kannikeswaran Nirupama
Children's Hospital of Michigan, Detroit, MI 48201, USA.
Clin Pediatr (Phila). 2010 May;49(5):422-31. doi: 10.1177/0009922809351090. Epub 2010 Jan 28.
Children with symptoms of bleeding and bruising are commonly seen in clinical practice. Primary care providers should be able to decide when and whether evaluation for bleeding disorder is warranted. This decision depends on one's index of suspicion for bleeding disorder based on history, physical examination, and screening laboratory investigations. Knowledge of the hemostatic physiology is essential to be able to order appropriate laboratory investigations and their accurate interpretation. Prothrombin time (PT), activated partial thromboplastin time (aPTT), and blood platelet concentration constitute the initial diagnostic work up of any bleeding disorder. Abnormality in any of these parameters in a child with excessive bleeding should lead to presumptive diagnosis of bleeding disorder and trigger referral to a hematologist for confirmation and definitive treatment. Awareness of basic treatment principles for management of bleeding/clotting disorders may prepare the provider to develop appropriate management plans, especially in a life threatening situation.
临床上常见有出血和瘀伤症状的儿童。初级保健提供者应能够决定何时以及是否有必要对出血性疾病进行评估。这一决定取决于基于病史、体格检查和筛查实验室检查对出血性疾病的怀疑指数。了解止血生理学对于能够安排适当的实验室检查及其准确解读至关重要。凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）和血小板浓度构成了对任何出血性疾病的初步诊断检查。出血过多儿童的这些参数中任何一项异常都应导致对出血性疾病的推定诊断，并促使转诊至血液科医生进行确诊和明确治疗。了解出血/凝血障碍管理的基本治疗原则可能会使提供者制定出适当的管理计划，尤其是在危及生命的情况下。
