16-Hemorrhage

Petechia (pxx021) (pxxo55) (pxx231) (pxx233) (pxx257) (pxx258), epistaxis, bloody wounds, bloody gums (bxx046), bloody sputum (scx006) (scx007), bloody stools (sfx015) (sfx014) (sfx008) (sfx026), sub corneal hemorrhage (yxx005), hematoma/ echymosis (pxx232) (pxx247) or hemorrhage anywhere else can be connected with hemostatic problems. We do not have many ways to treat because of lack of lab tests and suitable drugs.

Drugs we have access to:

• Vit K 1amp IV or IM 1 amp 1x/day for 3days
• Transamine 1tab 3x/day for many days (often useless)
• Adrenaline mixed with sterile water used topically for epistaxis, wounds…

Curative:

1. Stop diclofenac, aspirin, other NSAIDs…  Reduce corticoids…
2. Check if cause of hemorrhage could be one of the following drugs: Bactrim, chloramphenicol, sulfa.  Difficult to know, of course, but for security, often we stop these drugs if it is possible.  (bxx050) (pxx258) See "Allergy"
3. If patient takes TB drugs or TOXO drugs, check if receiving also folic acid...  If not, you must give it!
4. If patient has red blood mixed with feces, give metronidazole 400mg 3x/day (scx006) (scx015)
5. If gastric origin is possible (epigastric pain,stomach ache, melena (scx008)(sfx026)), give cimetidine 400mg 2-3x/day
6. If bloody sputum, think about TB.
7. Finally, think about idiopathic thrombocytopenic purpura (petechia...but no echymosis!), which is not rare in AIDS.  Treat with prednisolone (2 tabs 3x/day)... or dexa (4tabs in the morning + 1 tab at noon) as a last chance test if the hemorrhagic problem is more and more severe (connection possible with autoimmune problem)

NB "vascular hernia syndrome" is a strange bloody disease that we observe sometimes in our ward.  A few vascular hernias, full of blood, disseminated on the body, but especially on lips and border of former wounds.  On the lips, it can become a spectacular tumor...  For us, it seems that sulfa is the main cause.  See comments under photos:(bxx050) (pxx259) (pxx260)...// (bxx031) (bxx032)//See "protocol allergy"

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paul yves wery - aidspreventionpro@gmail.com

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