Re: Easy Bruising Patients - supplemental treatment ideas?

[Guest guest]

and why should it be treated at all?

 

Anybody have a supplemental treatment for patients with easy bruising - and negative basic workup?I'm sure we all see these 30-50 yo patients that complain of easy bruising, but seem to have not explanation for the problem.

Is there an easy supplement that might improve symptoms?I've thought about Vitamin K, but haven't seen anything specifically on this.Certainly increasing spinach and broccoli in the diet should be safe.

Any other recommendations.What do you use?thanks Locke, MD

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

[Guest guest]

HI ,

Along with Vitamin K, the other vitamins I think of are Vitamin C, B12 and folate. B12 and folate are easy enough to check but I believe Vitamin C has to be checked in a special sort of way (special tube/(?) temperature). So you may consider supplementing/checking those vitamins.

Soma

To: practiceimprovement1 < >; Clinical Procedures Sent: Mon, November 29, 2010 12:58:54 PMSubject: Easy Bruising Patients - supplemental treatment ideas?

Anybody have a supplemental treatment for patients with easy bruising - and negative basic workup?I'm sure we all see these 30-50 yo patients that complain of easy bruising, but seem to have not explanation for the problem.Is there an easy supplement that might improve symptoms?I've thought about Vitamin K, but haven't seen anything specifically on this.Certainly increasing spinach and broccoli in the diet should be safe.Any other recommendations.What do you use?thanks Locke, MD

[Guest guest]

About 30 years ago there was some information about using Vitamin C. We now that if you have scurvy that bruising is an issue. Don't know that it works. Avoiding aspirin and nsaids of course. Perhaps Vit E?

From: [ ] On Behalf Of Sangeetha Murthy [sangeethamurthy@...]

Sent: Monday, November 29, 2010 11:01 AM

To:

Cc: Clinical Procedures

Subject: Re: Easy Bruising Patients - supplemental treatment ideas?

and why should it be treated at all?

On Mon, Nov 29, 2010 at 9:58 AM, Locke

wrote:

Anybody have a supplemental treatment for patients with easy bruising - and negative basic workup?

I'm sure we all see these 30-50 yo patients that complain of easy bruising, but seem to have not explanation for the problem.

Is there an easy supplement that might improve symptoms?

I've thought about Vitamin K, but haven't seen anything specifically on this.

Certainly increasing spinach and broccoli in the diet should be safe.

Any other recommendations.

What do you use?

thanks

Locke, MD

--

Sangeetha Murthy M.D

7830 mont Mesa Blvd #287

San Diego, CA 92111

www.mypcponline.com

[Guest guest]

This is a thinning skin issue, not a blood vessel issue, and that is why the Vit C helps, it is a collagen precursor. If patients want to have the bruising go away faster, or prevent it for a procedure they have upcoming, they can take Arnica montana supplements, po or topical cream. This is an herbal, that increases the speed of clearance. Alot of plastics who do injectables, have patients take a Rx form ( from a compounding supply house) because it is stronger than the OTC form. I just tell people to buy it at the drug store, in the linaments area.

Cote' Easy Bruising Patients - supplemental treatment ideas?

Anybody have a supplemental treatment for patients with easy bruising - and negative basic workup?I'm sure we all see these 30-50 yo patients that complain of easy bruising, but seem to have not explanation for the problem.Is there an easy supplement that might improve symptoms?I've thought about Vitamin K, but haven't seen anything specifically on this.Certainly increasing spinach and broccoli in the diet should be safe.Any other recommendations.What do you use?thanks Locke, MD

[Guest guest]

Vitamin E and Vitamin C are also anticoagulants and can lead to

more bleeding and bruising.

I agree with the “why treat”. Some people just

have more fragile capillaries. Are you actually seeing the bruises?

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Kennedy, Jim

Sent: Monday, November 29, 2010 1:35 PM

To:

Subject: RE: Easy Bruising Patients - supplemental

treatment ideas?

About 30 years ago there was some information about using Vitamin

C. We now that if you have scurvy that bruising is an issue. Don't know that it

works. Avoiding aspirin and nsaids of course. Perhaps Vit E?

From:

[ ] On Behalf Of Sangeetha Murthy

[sangeethamurthy@...]

Sent: Monday, November 29, 2010 11:01 AM

To:

Cc: Clinical Procedures

Subject: Re: Easy Bruising Patients -

supplemental treatment ideas?

and why should it be treated at all?

Anybody have a supplemental treatment for patients with easy

bruising - and negative basic workup?

I'm sure we all see these 30-50 yo patients that complain of easy bruising, but

seem to have not explanation for the problem.

Is there an easy supplement that might improve symptoms?

I've thought about Vitamin K, but haven't seen anything specifically on this.

Certainly increasing spinach and broccoli in the diet should be safe.

Any other recommendations.

What do you use?

thanks

Locke, MD

--

Sangeetha Murthy M.D

7830 mont Mesa Blvd #287

San Diego, CA 92111

www.mypcponline.com

CyberDefender has scanned this email for potential threats.

Version 2.0 / Build 4.03.29.01

Get free PC security at http://www.cyberdefender.com

[Guest guest]

i usually ask if bruising is more so around periods. if this is so, i dont do

anything. gingko, vit e, fish oil contributes to it a lot. otc vitamin k has

helped with some.

g

>

>

>

> Anybody have a supplemental treatment for patients with easy bruising - and

> negative basic workup?

>

> I'm sure we all see these 30-50 yo patients that complain of easy bruising,

> but seem to have not explanation for the problem.

>

> Is there an easy supplement that might improve symptoms?

>

> I've thought about Vitamin K, but haven't seen anything specifically on

> this.

> Certainly increasing spinach and broccoli in the diet should be safe.

>

> Any other recommendations.

>

> What do you use?

>

> thanks

>

> Locke, MD

>

>

>

>

> --

> Sangeetha Murthy M.D

>

> 7830 mont Mesa Blvd #287

>

> San Diego, CA 92111

>

> www.mypcponline.com

>

>

>

>

>

>

>

> CyberDefender has scanned this email for potential threats.

> Version 2.0 / Build 4.03.29.01

> Get free PC security at http://www.cyberdefender.com

>

[Guest guest]

Thanks for the replies from everyone.This article mentioned by Dr. is pretty good - I'll forward it to the patient.http://www.bidmc.org/YourHealth/TherapeuticCenters/SkinDisorders.aspx?ChunkID=21437

In regards to " why treat " -- she is young - and who wants to run around with 1-3 inch bruises all the time?She says some friends (only half joking) have asked about whether her husband is beating her (no, he isn't).

I can see why it's a bummer for her. She is young (30's) and would like to dress other than a nun - covering everything up every time she bumps into a table or somesuch.I've offered for her to get a specialty opinion on further workup.

She's not having nosebleeds, heavy periods, etc - just the bruising.Thanks again for everyone's feedback. Locke, MD

[Guest guest]

I always double check to see what doses of aspirin, NSAIDs, Fish oil and Flax they are taking. Have seen increased bruising with just moderate doses of Fish Oil.CarlaTo: practiceimprovement1 < >; Clinical Procedures Sent: Mon,

November 29, 2010 10:58:54 AMSubject: Easy Bruising Patients - supplemental treatment ideas?

Anybody have a supplemental treatment for patients with easy bruising - and negative basic workup?I'm sure we all see these 30-50 yo patients that complain of easy bruising, but seem to have not explanation for the problem.

Is there an easy supplement that might improve symptoms?I've thought about Vitamin K, but haven't seen anything specifically on this.Certainly increasing spinach and broccoli in the diet should be safe.

Any other recommendations.What do you use?thanks Locke, MD

[Guest guest]

Easy bruising is a very common sign of SPLEEN Qi deficiency in Traditional Chinese Medicine. SPLEEN Qi is the master of Blood. The patient should avoid sugar as much as possible.OPC aniti-oxidant or Vitamin C is good in general. Copper is helpful too. Bromelin (enzyme from pineapple) if the patient also has other "itis"-arthritis or tendenitis. Horse chestnut if the patient also has varicose viens.HelenTo: From: carlygold@...Date: Mon, 29 Nov 2010 15:54:47 -0800Subject: Re: Easy Bruising Patients - supplemental treatment ideas?

I always double check to see what doses of aspirin, NSAIDs, Fish oil and Flax they are taking. Have seen increased bruising with just moderate doses of Fish Oil.CarlaTo: practiceimprovement1 < >; Clinical Procedures Sent: Mon,

November 29, 2010 10:58:54 AMSubject: Easy Bruising Patients - supplemental treatment ideas?

Anybody have a supplemental treatment for patients with easy bruising - and negative basic workup?I'm sure we all see these 30-50 yo patients that complain of easy bruising, but seem to have not explanation for the problem.

Is there an easy supplement that might improve symptoms?I've thought about Vitamin K, but haven't seen anything specifically on this.Certainly increasing spinach and broccoli in the diet should be safe.

Any other recommendations.What do you use?thanks Locke, MD

[Guest guest]

---

What do you mean by a 'negative basic workup " ?

Ellen

IM/Heme

>

> Anybody have a supplemental treatment for patients with easy bruising

> - and negative basic workup?

>

> I'm sure we all see these 30-50 yo patients that complain of easy

> bruising, but seem to have not explanation for the problem.

>

> Is there an easy supplement that might improve symptoms?

>

> I've thought about Vitamin K, but haven't seen anything specifically

> on this.

> Certainly increasing spinach and broccoli in the diet should be safe.

>

> Any other recommendations.

>

> What do you use?

>

> thanks

>

> Locke, MD

>

>

Attachment: vcard [not shown]

[Guest guest]

Are you sure the pts aren't taking any supplements that might be causing

the bruising?

>

> Anybody have a supplemental treatment for patients with easy bruising

> - and negative basic workup?

>

> I'm sure we all see these 30-50 yo patients that complain of easy

> bruising, but seem to have not explanation for the problem.

>

> Is there an easy supplement that might improve symptoms?

>

> I've thought about Vitamin K, but haven't seen anything specifically

> on this.

> Certainly increasing spinach and broccoli in the diet should be safe.

>

> Any other recommendations.

>

> What do you use?

>

> thanks

>

> Locke, MD

>

>

Attachment: vcard [not shown]

[Guest guest]

If she is having that much bruising, perhaps she needs more than a basic

workup. She might have Von Willebrand's and that's not always easy to

diagnose.

And it requires specific tests, not simply CBC with plts, PT/INR, PTT.

Find a lab that does a good battery of special coagulation tests and do

some more testing yourself.

If anything comes up, then perhaps she'll to to see a hematologist.

>

> Thanks for the replies from everyone.

>

> This article mentioned by Dr. is pretty good - I'll forward

> it to the patient.

>

>

http://www.bidmc.org/YourHealth/TherapeuticCenters/SkinDisorders.aspx?ChunkID=21\

437

>

> In regards to " why treat " -- she is young - and who wants to run

> around with 1-3 inch bruises all the time?

> She says some friends (only half joking) have asked about whether her

> husband is beating her (no, he isn't).

> I can see why it's a bummer for her. She is young (30's) and would

> like to dress other than a nun - covering everything up every time she

> bumps into a table or somesuch.

>

> I've offered for her to get a specialty opinion on further workup.

> She's not having nosebleeds, heavy periods, etc - just the bruising.

>

> Thanks again for everyone's feedback.

>

> Locke, MD

>

>

>

Attachment: vcard [not shown]

[Guest guest]

I asked her - she said she takes no supplements at all.

 

Locke, MD

 

Are you sure the pts aren't taking any supplements that might be causing the bruising? >

> Anybody have a supplemental treatment for patients with easy bruising > - and negative basic workup?>> I'm sure we all see these 30-50 yo patients that complain of easy > bruising, but seem to have not explanation for the problem.

>> Is there an easy supplement that might improve symptoms?>> I've thought about Vitamin K, but haven't seen anything specifically > on this.> Certainly increasing spinach and broccoli in the diet should be safe.

>> Any other recommendations.>> What do you use?>> thanks>> Locke, MD>>

[Guest guest]

Very basic testing - CBC, PT/PTT, Platelet function testing. All normal.

Also, review of systems - no epistaxis, heavy menses.

 

I could probably order some tests - but she is reluctant to spend a lot due to high deductible on her insurance.

 

The workups can be varied, but beyond a VonWillibrand's workup - what else would you order?

 

Here is one suggestion for workup...

 

http://www.pathologyoutlines.com/topic/coagulationalgorithmheredbleeding.html

 

Laboratory=========================================================================

â— Basic screening tests include CBC, PT/PTT, bleeding time or platelet function assay (e.g. PFA-100), thrombin time, peripheral blood smear review (for platelet and erythrocyte morphology), fibrinogen

◠Testing for vWD includes Factor VIII activity, vWF antigen, vWF activity (often done by the “ristocetin cofactor†method) ◠These results may lead to ordering vWF multimer assays and blood type determination (type O patients have reduced vWF activity)

â— For suspected coagulation factor abnormalities: mixing studies, factor levels, Bethesda assay (to detect coagulation factor inhibitors); can confirm hereditary deficiency by determining factor levels in relatives â— For suspected platelet disorders: platelet aggregation studies, bone marrow aspirate and biopsy, platelet-associated immunoglobulin levels

◠Perform Factor XIII assay if delayed bleeding is present (often done by “urea clot lysis†method) ◠More esoteric assays include PAI-1 activity and antiplasmin ◠Note: lupus anticoagulants can cause prolongation of PTT, but are associated with thrombosis, not bleeding

â— Deficiencies of Factor XII, prekallikrein or high molecular weight kininogen do not cause bleeding but cause prolongation of PTT

http://emedicine.medscape.com/article/210104-diagnosis

 

Laboratory Studies

The plasma concentration of FVIII or FIX determines the severity of hemophilia.

Levels of these factors are assayed against a normal pooled-plasma standard, which is designated as having 100% activity or the equivalent of FVIII or FIX 1 U/mL. Patients' tested values ranging from 50-150% are considered in the normal range of variance.

Aging, pregnancy, contraceptives, and estrogen replacement therapies are associated with increased levels.

In term and healthy premature neonates, FIX values are lowered (20-50% of the normal level) and rise to normal levels after 6 months (hepatic immaturity). FVIII levels are normal during that period of life.

Spontaneous bleeding complications are severe in individuals with undetectable activity (<0.01 U/mL), moderate in individuals with activity (2-5% normal), and mild in individuals with factor levels greater than 5%.

Hemophilia A and hemophilia B protein deficiencies of the intrinsic pathway result in abnormal whole-blood clotting times, prothrombin times (PTs), and activated partial thromboplastin times (aPTTs).

FVIII and FIX activities are usually determined by using the 1-stage assay based on the aPTT.

Chromogenic assays or 2-stage assays have also been used to determine FVIII levels.

Differentiation of hemophilia A from von Willebrand disease is possible by observing normal or elevated levels of von Willebrand factor antigen and ristocetin cofactor activity. Bleeding time is prolonged in patients with von Willebrand disease but normal in patients with hemophilia.

Laboratory confirmation of a FVIII or FIX inhibitor is clinically important when bleeding is not controlled after adequate amounts of factor concentrate are infused during a bleeding episode.

For autoantibody and alloantibody inhibitors, obtain a repeat measurement of the patient's prolonged aPTT after incubating the patient's plasma with normal plasma at 37°C for 1-2 hours.

If the prolonged aPTT is not corrected, use the Bethesda method to titrate the inhibitor biologic concentration. By convention, more than 0.6 BU is considered a positive result for an inhibitor, less than 5 BU is considered a low titer of inhibitor, and more than 10 BU is a high titer (neutralizing effectiveness of factor concentrate therapy to control bleeding).

Locke, MD

 

---What do you mean by a 'negative basic workup " ?EllenIM/Heme

>> Anybody have a supplemental treatment for patients with easy bruising > - and negative basic workup?>> I'm sure we all see these 30-50 yo patients that complain of easy

> bruising, but seem to have not explanation for the problem.>> Is there an easy supplement that might improve symptoms?>> I've thought about Vitamin K, but haven't seen anything specifically

> on this.> Certainly increasing spinach and broccoli in the diet should be safe.>> Any other recommendations.>> What do you use?>> thanks>> Locke, MD

>>

[Guest guest]

I once had a pt who had elevated INR during a pre op work up. Further testing showed he was hypothyroid. That was corrected and his INR corrected too. He had VWF done and he did not have that disease

 

Very basic testing - CBC, PT/PTT, Platelet function testing. All normal.

Also, review of systems - no epistaxis, heavy menses.

 

I could probably order some tests - but she is reluctant to spend a lot due to high deductible on her insurance.

 

The workups can be varied, but beyond a VonWillibrand's workup - what else would you order?

 

Here is one suggestion for workup...

 

http://www.pathologyoutlines.com/topic/coagulationalgorithmheredbleeding.html

 

Laboratory=========================================================================

â— Basic screening tests include CBC, PT/PTT, bleeding time or platelet function assay (e.g. PFA-100), thrombin time, peripheral blood smear review (for platelet and erythrocyte morphology), fibrinogen

◠Testing for vWD includes Factor VIII activity, vWF antigen, vWF activity (often done by the “ristocetin cofactor†method) ◠These results may lead to ordering vWF multimer assays and blood type determination (type O patients have reduced vWF activity)

â— For suspected coagulation factor abnormalities: mixing studies, factor levels, Bethesda assay (to detect coagulation factor inhibitors); can confirm hereditary deficiency by determining factor levels in relatives â— For suspected platelet disorders: platelet aggregation studies, bone marrow aspirate and biopsy, platelet-associated immunoglobulin levels

◠Perform Factor XIII assay if delayed bleeding is present (often done by “urea clot lysis†method) ◠More esoteric assays include PAI-1 activity and antiplasmin ◠Note: lupus anticoagulants can cause prolongation of PTT, but are associated with thrombosis, not bleeding

â— Deficiencies of Factor XII, prekallikrein or high molecular weight kininogen do not cause bleeding but cause prolongation of PTT

http://emedicine.medscape.com/article/210104-diagnosis

 

Laboratory Studies

The plasma concentration of FVIII or FIX determines the severity of hemophilia.

Levels of these factors are assayed against a normal pooled-plasma standard, which is designated as having 100% activity or the equivalent of FVIII or FIX 1 U/mL. Patients' tested values ranging from 50-150% are considered in the normal range of variance.

Aging, pregnancy, contraceptives, and estrogen replacement therapies are associated with increased levels.

In term and healthy premature neonates, FIX values are lowered (20-50% of the normal level) and rise to normal levels after 6 months (hepatic immaturity). FVIII levels are normal during that period of life.

Spontaneous bleeding complications are severe in individuals with undetectable activity (<0.01 U/mL), moderate in individuals with activity (2-5% normal), and mild in individuals with factor levels greater than 5%.

Hemophilia A and hemophilia B protein deficiencies of the intrinsic pathway result in abnormal whole-blood clotting times, prothrombin times (PTs), and activated partial thromboplastin times (aPTTs).

FVIII and FIX activities are usually determined by using the 1-stage assay based on the aPTT.

Chromogenic assays or 2-stage assays have also been used to determine FVIII levels.

Differentiation of hemophilia A from von Willebrand disease is possible by observing normal or elevated levels of von Willebrand factor antigen and ristocetin cofactor activity. Bleeding time is prolonged in patients with von Willebrand disease but normal in patients with hemophilia.

Laboratory confirmation of a FVIII or FIX inhibitor is clinically important when bleeding is not controlled after adequate amounts of factor concentrate are infused during a bleeding episode.

For autoantibody and alloantibody inhibitors, obtain a repeat measurement of the patient's prolonged aPTT after incubating the patient's plasma with normal plasma at 37°C for 1-2 hours.

If the prolonged aPTT is not corrected, use the Bethesda method to titrate the inhibitor biologic concentration. By convention, more than 0.6 BU is considered a positive result for an inhibitor, less than 5 BU is considered a low titer of inhibitor, and more than 10 BU is a high titer (neutralizing effectiveness of factor concentrate therapy to control bleeding).

Locke, MD

 

---What do you mean by a 'negative basic workup " ?EllenIM/Heme

>> Anybody have a supplemental treatment for patients with easy bruising > - and negative basic workup?>> I'm sure we all see these 30-50 yo patients that complain of easy

> bruising, but seem to have not explanation for the problem.>> Is there an easy supplement that might improve symptoms?>> I've thought about Vitamin K, but haven't seen anything specifically

> on this.> Certainly increasing spinach and broccoli in the diet should be safe.>> Any other recommendations.>> What do you use?>> thanks>> Locke, MD

>>

-- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.

This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above.

 If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error.

[Guest guest]

,

Do you even see any bruises? My IMH questionnaire

always asks people if they have easy bruising. About ¨ö say yes. I

say they just have unrealistic expectations. Also, thinner people will have

more obvious bruising than people with thick subcutaneous fat to absorb blows.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Locke

Sent: Tuesday, November 30, 2010 12:21 PM

To:

Subject: Re: Easy Bruising Patients - supplemental

treatment ideas?

Very basic testing - CBC, PT/PTT, Platelet function testing.

All normal.

Also, review of systems - no epistaxis, heavy menses.

I could probably order some tests - but she is reluctant to

spend a lot due to high deductible on her insurance.

The workups can be varied, but beyond a VonWillibrand's

workup - what else would you order?

Here is one suggestion for workup...

http://www.pathologyoutlines.com/topic/coagulationalgorithmheredbleeding.html

Laboratory

=========================================================================

¡Ü Basic

screening tests include CBC, PT/PTT, bleeding time or platelet function assay

(e.g. PFA-100), thrombin time, peripheral blood smear review (for platelet and

erythrocyte morphology), fibrinogen

¡Ü Testing for vWD includes Factor VIII activity, vWF antigen, vWF activity

(often done by the ¡°ristocetin cofactor¡± method)

¡Ü These results may lead to ordering vWF multimer assays and blood type

determination (type O patients have reduced vWF activity)

¡Ü For suspected coagulation factor abnormalities: mixing studies, factor

levels, Bethesda assay (to detect coagulation factor inhibitors); can confirm

hereditary deficiency by determining factor levels in relatives

¡Ü For suspected platelet disorders: platelet aggregation studies, bone marrow

aspirate and biopsy, platelet-associated immunoglobulin levels

¡Ü Perform Factor XIII assay if delayed bleeding is present (often done by ¡°urea

clot lysis¡± method)

¡Ü More esoteric assays include PAI-1 activity and antiplasmin

¡Ü Note: lupus anticoagulants can cause

prolongation of PTT, but are associated with thrombosis, not bleeding

¡Ü Deficiencies of Factor XII, prekallikrein or high molecular weight kininogen

do not cause bleeding but cause prolongation of PTT

http://emedicine.medscape.com/article/210104-diagnosis

Laboratory Studies

The

plasma concentration of FVIII or FIX determines the severity of

hemophilia.

Levels of these factors are assayed against

a normal pooled-plasma standard, which is designated as having 100%

activity or the equivalent of FVIII or FIX 1 U/mL. Patients' tested

values ranging from 50-150% are considered in the normal range of

variance.

Aging, pregnancy, contraceptives, and estrogen

replacement therapies are associated with increased levels.

In term and healthy premature neonates, FIX

values are lowered (20-50% of the normal level) and rise to normal levels

after 6 months (hepatic immaturity). FVIII levels are normal during that

period of life.

Spontaneous bleeding complications are

severe in individuals with undetectable activity (<0.01 U/mL),

moderate in individuals with activity (2-5% normal), and mild in

individuals with factor levels greater than 5%.

Hemophilia A and hemophilia B protein

deficiencies of the intrinsic pathway result in abnormal whole-blood

clotting times, prothrombin times (PTs), and activated partial

thromboplastin times (aPTTs).

FVIII and FIX activities are usually

determined by using the 1-stage assay based on the aPTT.

Chromogenic assays or 2-stage assays have

also been used to determine FVIII levels.

Differentiation of hemophilia A from von

Willebrand disease is possible by observing normal or elevated levels of

von Willebrand factor antigen and ristocetin cofactor activity. Bleeding

time is prolonged in patients with von Willebrand disease but normal in

patients with hemophilia.

Laboratory confirmation of a FVIII or FIX

inhibitor is clinically important when bleeding is not controlled after

adequate amounts of factor concentrate are infused during a bleeding

episode.

For autoantibody and alloantibody

inhibitors, obtain a repeat measurement of the patient's prolonged aPTT

after incubating the patient's plasma with normal plasma at 37¡ÆC for 1-2

hours.

If the prolonged aPTT is not corrected, use

the Bethesda method to titrate the inhibitor biologic concentration. By

convention, more than 0.6 BU is considered a positive result for an

inhibitor, less than 5 BU is considered a low titer of inhibitor, and more

than 10 BU is a high titer (neutralizing effectiveness of factor

concentrate therapy to control bleeding).

Locke, MD

---

What do you mean by a 'negative basic workup " ?

Ellen

IM/Heme

>

> Anybody have a supplemental treatment for patients with easy bruising

> - and negative basic workup?

>

> I'm sure we all see these 30-50 yo patients that complain of easy

> bruising, but seem to have not explanation for the problem.

>

> Is there an easy supplement that might improve symptoms?

>

> I've thought about Vitamin K, but haven't seen anything specifically

> on this.

> Certainly increasing spinach and broccoli in the diet should be safe.

>

> Any other recommendations.

>

> What do you use?

>

> thanks

>

> Locke, MD

>

>

CyberDefender has scanned this email for potential threats.

Version 2.0 / Build 4.03.29.01

Get free PC security at http://www.cyberdefender.com

[Guest guest]

Good points, Kathy.

No, I didn't see any bruises on day of exam.

She is normal weight.

Locke, MD

2010/11/30 Kathy Saradarian, MD

 

,

Do you even see any bruises?   My IMH questionnaire always asks people if they have easy bruising.  About ½ say yes.  I say they just have unrealistic expectations.  Also, thinner people will have more obvious bruising than people with thick subcutaneous fat to absorb blows.

 

 

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

 

 

[Guest guest]

My wife has borderline Von Willebrand's- which is the most common of

the easy bleeding coagulopathies. The specific test is a QUANTITATIVE

Von Willebrand factor- these folks usually run around 60%, and that's

just about the cusp. Any lower, they bleed, any higher, they don't.

It's usually discovered incidentally because they bleed too much with

surgery. Her first C-Section was the first the OB had ever had to use

a drain on postop; the second she needed 4 units of blood and dropped

her pressure to 40/0. Much too exciting. After that, as a resident,

I did some research. Preop, using ADH for a day or two bumps up the

VW factor enough to be no problem.

Turns out lots of things have some anticoagulant effect. Aspirin, of

course; other NSAIDS, some. Fish oil. Vitamin E- mild. Tree ear

fungus (moo-er) like in hot and sour soup- has adenosine, which is a

fairly potent AC. (Back in 1984, a CPC in NEJM started as, " A 28 y/o

w/m presented with a CC of an increased prothrombin time. " Odd CC,

no?) Worth asking about herbals, vitamins, supplements, FH. Good luck.

Going the other way, protein C or S deficiencies are fairly common

causes of increased clotting.