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5: ACQUIRED COAGULATION DISORDERS

Kay Tasso, PhD, PT, PCS; Eric Shamus, PhD, DPT, PT, CSCS; Wendy Song, DO

CONDITION/DISORDER SYNONYMS

  • Coagulation defects

  • Disorders of blood coagulation

ICD-9-CM CODES1

  • 286.5 Hemorrhagic disorder due to intrinsic circulating anticoagulants

  • 286.52 Acquired hemophilia

  • 286.53 Antiphospholipid antibody with hemorrhagic disorder

  • 286.59 Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors

ICD-10-CM CODES2

  • D68.311 Acquired hemophilia

  • D68.312 Antiphospholipid antibody with hemorrhagic disorder

  • D68.318 Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors

PREFERRED PRACTICE PATTERNS

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Connective Tissue Dysfunction3

PATIENT PRESENTATION

A 52-year-old male presents with a deep thigh bruise and knee pain from a fall 1 week ago. The patient has a history of celiac disease has noticed increased bruising and prolonged gum bleeding after brushing his teeth for the past week. He has not adhered to his gluten-free diet due to hectic work hours as a police officer. Vitals are: Temperature: 98.2 °F, Pulse: 84, Respirations: 16, Blood Pressure: 130/86, and SpO2% of 98%. Physical examination shows diffuse small ecchymosis on his upper and lower extremities with gingival petechiae. Laboratory tests show a normal hemoglobin and platelet count with a prolonged prothrombin time (PT) and mildly elevated partial PT.

FIGURE 5-1

Bleeding disorders, inherited: Evaluation of suspected inherited bleeding disorders. PAI-1, plasminogen activator inhibitor 1; PFA-100 CT, platelet function analyzer-100 closure time; PT, prothrombin time; PTT, partial thromboplastin time; TT, thrombin time; vWD, von Willebrand disease; vWF, von Willebrand factor. (From Nicoll D, Mark Lu C, Pignone M, Mcphee SJ. Pocket Guide to Diagnostic Tests, 6th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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KEY FEATURES

Description

  • Disorders involving slower than normal blood clotting

  • Occurs spontaneously or as an excessive response to injury leading to bleeding into joints (termed hemarthrosis) or tissues

Essentials of Diagnosis

  • Classification

    • Hepatic disease

    • Vitamin K deficiency

    • Renal disease

  • Laboratory values

  • Identifying the underlying cause

General Considerations

  • Vitamin K deficiency can be a result of malabsorption disorders

  • Liver disorders

    • Decreased synthesis of coagulation

    • Impaired clearance of activated hemostatic components

Demographics

  • Acquired or hereditary.

  • Factor V Leiden mutation in 5% of Caucasian population.

  • Vitamin K deficiency can occur in a newborn or later stages in life where there is intestinal malabsorption.4

CLINICAL FINDINGS

SIGNS AND SYMPTOMS4

  • Shock including end-organ dysfunction

  • Diffuse bleeding

    • Hematuria

    • Melena

    • Purpura

    • Petechiae

  • Thrombotic lesions

    • Major vessel thrombosis

    • Purpura fulminans

FIGURE 5-2

Structure of a normal platelet. ADP, adenosine diphosphate. (From Chandrasoma ...

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