title: Approach to a child with bleeding in the emergency room.
abstract: A bleeding child is a cause of great concern and often, panic, for parents and pediatricians alike. Causes of bleeding could be trivial or secondary to an underlying bleeding disorder or a potentially serious systemic illness. Based on etiology, they can be categorized into disorders affecting platelets or the coagulation cascade and can be inherited or acquired. A systematic approach with relevant clinical history and examination along with appropriate laboratory investigations aid in reaching the diagnosis promptly. Indication and administration of blood products including fresh frozen plasma, cryoprecipitate, random donor and single donor apheresis platelets is elaborated. Management of hemophilia, Von Willebrand disease, disseminated intravascular coagulation and bleeding in cyanotic congenital heart disease, among other causes is outlined. Role of antifibrinolytic therapy, desmopressin and recombinant factor VIIa is briefly described. The review outlines the approach to a bleeding child in the emergency room. Practical points in history, examination, investigations and management are discussed. Management in resource constraint setting of developing countries is addressed.
authors.affiliation: Hematology -Oncology Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Bansal
authors.forename: Sapna
authors.initials: S
authors.lastname: Oberoi
authors.forename: R K
authors.initials: RK
authors.lastname: Marwaha
authors.forename: Sunit C
authors.initials: SC
authors.lastname: Singhi
mesh_terms: D001778:Blood Coagulation Disorders / Q000145:classification / Q000150:complications* / Q000503:physiopathology; D001791:Blood Platelet Disorders / Q000145:classification / Q000150:complications* / Q000503:physiopathology; D002648:Child; D019468:Disease Management; D004632:Emergency Medical Services / Q000379:methods; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006401:Hematologic Agents / Q000627:therapeutic use*; D006470:Hemorrhage / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006489:Hemostatic Techniques; D006801:Humans; D017063:Outcome Assessment, Health Care; D063189:Symptom Assessment
chemical_list: D006401:Hematologic Agents