Hemorrhagic syndromes in the practice of a general practitioner (lecture for practicing physicians, p. 1)
https://doi.org/10.21886/2712-8156-2025-6-2-106-117
Abstract
Hemorrhagic syndrome occurs as a result of vascular wall damage, disturbance of the structure, function and number of platelets, coagulation hemostasis disorders. For diagnosis, not only laboratory parameters are important, but also complete information about the patient’s condition, history, comorbidity, heredity, ongoing treatment. The use of standardized tools such as ISTH-SSC BAT scale, bleeding risk scales help in diagnosis and determination of patient management tactics. The causes of hemorrhagic syndrome of hereditary genesis are more often thrombocytopathies, hemophilia, Willebrand’s disease, telangiectasia; acquired - secondary thrombocytopenia and thrombocytopathies, DIC, prothrombin complex factor deficiency, hemorrhagic vasculitis, as well as drugs (antithrombotic, cytostatics, antibiotics and others). The clinician has an important role in diagnosis and treatment, which requires knowledge of modern guidelines, clinical recommendations, instructions, standards and other regulatory documents.
About the Authors
E. V. BurnashevaRussian Federation
Eva V. Burnasheva, MD, PhD, Associate professor, Department of Internal Medicine No. 2
Rostov-on-Don
Yu. V. Shatokhin
Russian Federation
Yurii V. Shatokhin, MD, PhD, Prof. Department of Hematology and Transfusiology
Rostov-on-Don
I. V. Snezhko
Russian Federation
Irina V. Snezhko, MD, PhD, Associate Professor, Department of Hematology and Transfusiology
Rostov-on-Don
A. A. Matsuga
Russian Federation
Andrey A. Matsuga, hematologist of the State Budgetary Institution RO “CDC “Health” in Rostov-on-Don”, Associate professor, Department of Hematology and Transfusiology (with courses in clinical laboratory diagnostics, genetics and laboratory genetics)
Rostov-on-Don
E. V. Ryabikina
Russian Federation
Elena V. Ryabikina, MD, PhD, Associate professor, Department of Hematology and Transfusiology
Rostov-on-Don
E. V. Degtereva
Russian Federation
Elena V. Degtereva, MD, PhD, Associate Professor of the Department of Hematology and Transfusiology (with courses in clinical laboratory diagnostics, genetics and laboratory genetics)
Rostov-on-Don
References
1. Barkagan Z.S. Gemorragicheskie zabolevaniya i sindromy. 2-e izd., pererab. i dop. Moscow: Meditsina; 1988. (In Russ.)
2. Vorob’ev A.I., ed. Rukovodstvo po gematologii: v 3t. T. 3. Moscow: N’yudiamed; 2005. (In Russ.)
3. Rukavitsyn O.A., Ignat’ev S.V., eds. Sistema gemostaza. Teoreticheskie osnovy i klinicheskaya praktika: natsional’noe rukovodstvo. Moscow: GEHOTAR – Media; 2024. (In Russ.)
4. Zabolotskikh I.B., Sinkov S.V., Bulanov A.Y., Vorobyova N.A., Eremenko A.A., et al. Perioperative management of patients with hemostatic system disorders. Methodological recommendations of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists” and the National Association of Specialists in Thrombosis, Clinical Hemostasiology and Hemorheology. Annals of Critical Care. 2024;(1):7–46. (In Russ.) https://doi.org/10.21320/1818-474X-2024-1-7-46.
5. DeLoughery TG. Hemostasis and Thrombosis. Fourth Edution. Springer; 2019.
6. Rodeghiero F, Tosetto A, Abshire T, Arnold DM, Coller B, James P, et al. ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders. J Thromb Haemost. 2010;8(9):2063-2065. https://doi.org/10.1111/j.1538-7836.2010.03975.x
7. Kalot MA, Husainat N, Tayiem S, El Alayli A, Dimassi AB, Diab O, Abughanimeh O, Madoukh B, Qureini A, Ameer B, Di Paola J, Eikenboom JCJ, Jacobs-Pratt V, McLintock C, Montgomery R, O’Donnell JS, Sidonio R, Brignardello-Petersen R, Flood V, Connell NT, James PD, Mustafa RA. Bleeding assessment tools in the diagnosis of VWD in adults and children: a systematic review and meta-analysis of test accuracy. Blood Adv. 2021;5(23):5023-5031. https://doi.org/10.1182/bloodadvances.2021004368
8. Rodeghiero F, Michel M, Gernsheimer T, Ruggeri M, Blanchette V, Bussel JB, et al. Standardization of bleeding assessment in immune thrombocytopenia: report from the International Working Group. Blood. 2013;121(14):2596-2606. https://doi.org/10.1182/blood-2012-07-442392
9. Yafoshkina T.U., Florinskiy D.B., Pshonkin A.V., Fedorova D.V., Poletaev A.V., Seregina E.A., et al. Evaluation of the sensitivity and specificity of the Pediatric bleeding questionnaire in various hemorrhagic disorders. Pediatria n.a. G.N. Speransky. 2021;100(3):35–41. (In Russ.) https://doi.org/10.24110/0031-403X-2021-100-3-35-41
10. Klinicheskie rekomendatsii «Anomal’nye matochnye krovotecheniYA» (utv. Ministerstvom zdravookhraneniya Rossiiskoi Federatsii, 2024). (In Russ.)
11. Heavy menstrual bleeding: assessment and management. London: National Institute for Health and Care Excellence (NICE); 2021. PMID: 29634173.
12. Rodeghiero F, Kadir RA, Tosetto A, James PD. Relevance of quantitative assessment of bleeding in haemorrhagic disorders. Haemophilia. 2008;14 Suppl 3:68-75. https://doi.org/10.1111/j.1365-2516.2008.01714.x
13. Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol. 2017;40:3-22. https://doi.org/10.1016/j.bpobgyn.2016.09.011
14. Singh S, Best C, Dunn S, Leyland N, Wolfman WL. No. 292-Abnormal Uterine Bleeding in Pre-Menopausal Women. J Obstet Gynaecol Can. 2018;40(5):e391-e415. https://doi.org/10.1016/j.jogc.2018.03.007
15. Tosetto A, Castaman G, Plug I, Rodeghiero F, Eikenboom J. Prospective evaluation of the clinical utility of quantitative bleeding severity assessment in patients referred for hemostatic evaluation. J Thromb Haemost. 2011;9(6):1143-1148. https://doi.org/10.1111/j.1538-7836.2011.04265.x
16. Seliverstov EI, Lobastov KV, Ilyukhin EA, Apkhanova T.V., Akhmetzyanov R.V., Akhtyamov I.F., et al. Prevention, Diagnostics and Treatment of Deep Vein Thrombosis. Russian Experts Consensus. Journal of Venous Disorders. 2023;17(3):152‑296. (In Russ.) https://doi.org/10.17116/flebo202317031152
17. Buryachkovskaya L.I., Lomakin N. V., Sumarokov A.B., Shirokov E.A. Algoritmy i shkaly riska tromboza i krovotecheniya v kardiologii i nevrologii. Prakticheskoe posobie. 2018. (In Russ.)
18. Neutze D, Roque J. Clinical Evaluation of Bleeding and Bruising in Primary Care. Am Fam Physician. 2016;93(4):279-286. PMID: 26926815.
19. Tiede A, Collins P, Knoebl P, Teitel J, Kessler C, Shima M, Di Minno G, d’Oiron R, Salaj P, Jiménez-Yuste V, Huth-Kühne A, Giangrande P. International recommendations on the diagnosis and treatment of acquired hemophilia A. Haematologica. 2020;105(7):1791-1801. https://doi.org/10.3324/haematol.2019.230771
20. Moenen FCJI, Nelemans PJ, Schols SEM, Schouten HC, Henskens YMC, Beckers EAM. The diagnostic accuracy of bleeding assessment tools for the identification of patients with mild bleeding disorders: A systematic review. Haemophilia. 2018;24(4):525-535. https://doi.org/10.1111/hae.13486
Review
For citations:
Burnasheva E.V., Shatokhin Yu.V., Snezhko I.V., Matsuga A.A., Ryabikina E.V., Degtereva E.V. Hemorrhagic syndromes in the practice of a general practitioner (lecture for practicing physicians, p. 1). South Russian Journal of Therapeutic Practice. 2025;6(2):106-117. (In Russ.) https://doi.org/10.21886/2712-8156-2025-6-2-106-117