UST Department of Pediatrics

Pediatrics 2-Module 1
Gastroenterology-Hematology-Cardiology module
Student’s guide on bleeding

#commonyetuncommon

Anna, an 11-year old female, Filipino, Roman Catholic from Sampaloc Manila was brought to the
Emergency Room due to profuse nosebleeding.

History of the Present Illness:

Two days prior to consult, Anna developed cough and colds. Few hours prior to consult, Anna
picked her nose removing the nasal discharge that dried up (booger). She pinched her nose and
put cold compress on her forehead. Bleeding was quite profuse. An hour later, she vomited
previously ingested food admixed with blood. She panicked and turned pale. However, she
remained conscious. She was immediately brought to UST Hospital Emergency Department for
consult.

PE: awake, anxious, ambulatory

BP= 100/60, CR= 110/min, RR=24/min, T= 37.0oC, Wt= 33 kg. Lt = 135 cm
Skin: with greenish discoloraYon on right thigh measuring 3 cm in widest diameter
Pink palpebral conjuncYvae, anicteric sclerae, intact tympanic membrane, (+) blood clot in
right nostril, with pale boggy turbinates in the right nostril, pinkish buccal mucosa, Grade
1 slightly hyperemic tonsils without exudates,
No enlarged cervical lymph nodes
Symmetrical chest expansion, no retracYons, resonant, clear breath sounds
Adynamic precordium, apex beat at 5th LICS MCL, normal heart sounds, no murmurs
Abdomen flat, bowel sounds 12 click/minute, tympaniYc on all quadrants, liver span 6.5 cm,
Traube’s space not obliterated, soa, non-tender
ExtremiYes; no gross deformiYes, no edema, pulses full and equal, CRT < 2 seconds

GUIDE QUESTIONS:

1. What historical data will you gather from the informant?

a. History of mucocutaneous bleeding or deep muscle and joint bleeding
b. Underlying medical condiYons that can cause hemostaYc derangement like liver disease,
malabsorpYon syndrome, Vitamin K deficiency, etc.
c. Intake of drugs like aspirin, NSADS, anYbioYcs, anYconvulsants
d. Family history of the same symptoms especially among the male relaYves
2. What are the salient features of the case?
3. Discuss the importance and clinical implicaYon of your physical examinaYon findings? How
will you correlate these physical findings with the possible cause/s of bleeding in this paYent?
4. What clinical condiYon/s would you consider given the above informaYon?
5. What laboratory examinaYons will you request for? Give the principles of each. Correlate the
expected results with the clinical condiYon of this paYent.
6. Interpret the results
7. What laboratory tests should be further requested if a primary bleeding disorder is highly
suspected?
9. How would you manage this paYent?

Please refer to Nelson’s textbook of Pediatrics 21th ed. Chapter 504, pp2589-2618