Abstract
Background: Subconjunctival hemorrage (SCH) is a frequent, mild bleeding manifestation and a common cause of consultation. Hemostatic alterations are possible causes of SCH but their role and prevalence is unknown. We assessed the prevalence of hemostatic abnormalities in patients with spontaneous, recurrent SCH to clarify the role of the hemostasis laboratory in this clinical setting.
Methods: A total of 105 SCH patients (21–78 years, 65 females) with no identifiable cause (hypertension-trauma-conjunctivitis) or concomitant treatments (NSAIDs- aspirin-oral anticoagulants-antiplatelet agents) and 53 age and sex-matched healthy controls (HCs) (22–72 years, 29 females) were evaluated for skin bleeding time, PFA-100®, blood clotting screening, platelet count, light transmission aggregomery, VWF:Ag, VWF:RCo, RIPA, FVIII activity, FXIII antigen and activity and ISTH Bleeding Severity Score (BSS).
Results: Prevalence of hemostatic abnormalities was not higher in the SCH population than in HCs BSS was 0.83 (95% CI 0.62–1.06) in SCH and 0.66 (0.37–0.95) in HC (p=NS). Type I Von Willebrand disease was diagnosed in one SCH and none HC patients, a prevalence not significantly different (p=NS by χ2).
Conclusions: The prevalence of hemostatic alterations in patients with recurrent, spontaneous SCH is not different from the general population; hemostatic screening or second level tests are of no use in patients with recurrent SCH and no other bleedings.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: This work was supported in part by a grant of Fondazione Cassa di Risparmio di Perugia (protocol n. 2013.0213.021) to PG.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Leibowitz HM. The red eye. N Engl J Med 2000;343:345–51.10.1056/NEJM200008033430507Search in Google Scholar
2. Cronau H, Kankanala RR, Mauger T. Diagnosis and management of red eye in primary care. Am Fam Physician 2010;81:137–44.Search in Google Scholar
3. Cagini C, Bartolini A, Iannone A, Fiore T, Fierro T, Gresele P. Epidemiology in an ophthalmic emergency centre: two years analysis causes of access for eye emergency [submitted].Search in Google Scholar
4. Fukuyama J, Hayasaka S, Yamada K, Setogawa T. Causes of subconjunctival hemorrhage. Ophthalmologica 1990;200:63–7.10.1159/000310079Search in Google Scholar
5. Wirbelauer C. Management of the red eye for the primary care physician. Am J Med 2006;119:302–6.10.1016/j.amjmed.2005.07.065Search in Google Scholar
6. Parmeggiani F, Costagliola C, Incorvaia C, Gemmati D, D’Angelo S, Tognazzo S, et al. Prevalence of factor XIII Val34Leu polymorphism in patients affected by spontaneous subconjunctival hemorrhage. Am J Ophthalmol 2004;138:481–4.10.1016/j.ajo.2004.03.017Search in Google Scholar
7. Groomer AE, Terry JE, Westblom TU. Subconjunctival and external hemorrhage secondary to oral anticoagulation. J Am Optom Assoc 1990;61:770–5.Search in Google Scholar
8. Quiroga T, Goycoolea M, Panes O, Aranda E, Martinez C, Belmont S, et al. High prevalence of bleeders of unknown cause among patients with inherited mucocutaneous bleeding. A prospective study of 280 patients and 299 controls. Haematologica 2007;92:357–65.10.3324/haematol.10816Search in Google Scholar
9. Philipp CS, Dilley A, Miller CH, Evatt B, Baranwal A, Schwartz L, et al. Platelet functional defects in women with unexplained menorrhagia. J Thromb Haemost 2003;1:477–84.10.1046/j.1538-7836.2003.00061.xSearch in Google Scholar
10. Dilley A, Drews C, Miller C, Lally C, Austin H, Ramaswamy D, et al. von Willebrand disease and other inherited bleeding disorders in women with diagnosed menorrhagia. Obstet Gynecol 2001;97:630–6.Search in Google Scholar
11. Kadir RA, Economides DL, Sabin CA, Owens D, Lee CA. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet 1998;351:485–9.10.1016/S0140-6736(97)08248-2Search in Google Scholar
12. Sandoval C, Dong S, Visintainer P, Ozkaynak MF, Jayabose S. Clinical and laboratory features of 178 children with recurrent epistaxis. J Pediatr Hematol Oncol 2002;24:47–9.10.1097/00043426-200201000-00013Search in Google Scholar PubMed
13. Jones GL, Browning S, Phillipps J. The value of coagulation profiles in epistaxis management. Int J Clin Pract 2003;57: 577–8.Search in Google Scholar
14. Elden L, Reinders M, Witmer C. Predictors of bleeding disorders in children with epistaxis: value of preoperative tests and clinical screening. Int J Pediatr Otorhinolaryngol 2012;76: 767–71.10.1016/j.ijporl.2012.02.033Search in Google Scholar PubMed
15. Tosetto A, Rodeghiero F, Castaman G, Goodeve A, Federici AB, Batlle J, et al. A quantitative analysis of bleeding symptoms in type 1 von Willebrand disease: results from a multicenter European study (MCMDM-1 VWD). J Thromb Haemost 2006;4: 766–73.10.1111/j.1538-7836.2006.01847.xSearch in Google Scholar PubMed
16. Ciferri S, Emiliani C, Guglielmini G, Orlacchio A, Nenci GG, Gresele P. Platelets release their lysosomal content in vivo in humans upon activation. Thromb Haemost 2000;83:157–64.10.1055/s-0037-1613772Search in Google Scholar
17. Gresele P, Migliacci R, Procacci A, De Monte P, Bonizzoni E. Prevention by NCX 4016, a nitric oxide-donating aspirin, but not by aspirin, of the acute endothelial dysfunction induced by exercise in patients with intermittent claudication. Thromb Haemost 2007;97:444–50.10.1160/TH06-10-0555Search in Google Scholar
18. Noris P, Klersy C, Gresele P, Giona F, Giordano P, Minuz P, et al. Platelet size for distinguishing between inherited thrombocytopenias and immune thrombocytopenia: a multicentric, real life study. Br J Haematol 2013;162:112–29.10.1111/bjh.12349Search in Google Scholar PubMed PubMed Central
19. Bafunno V, Favuzzi G, Fierro T, Chetta M, Mastrodicasa E, Chinni E, et al. Coinheritance of three novel FV gene mutations in a patient with a severe FV deficiency. Haemophilia 2012;18:e51–3.10.1111/j.1365-2516.2011.02747.xSearch in Google Scholar PubMed
20. Falcinelli E, Guglielmini G, Torti M, Gresele P. Intraplatelet signaling mechanisms of the priming effect of matrix metalloproteinase-2 on platelet aggregation. J Thromb Haemost 2005;3:2526–35.10.1111/j.1538-7836.2005.01614.xSearch in Google Scholar PubMed
21. Cattaneo M, Cerletti C, Harrison P, Hayward CP, Kenny D, Nugent D, et al. Recommendations for the standardization of light transmission aggregometry: a consensus of the working party from the platelet physiology subcommittee of SSC/ISTH. J Thromb Haemost 2013;11:1183–9.10.1111/jth.12231Search in Google Scholar PubMed
22. Crescente M, Mezzasoma AM, Del Pinto M, Palmerini F, Di Castelnuovo A, Cerletti C, et al. Incomplete inhibition of platelet function as assessed by the platelet function analyzer (PFA-100) identifies a subset of cardiovascular patients with high residual platelet response while on aspirin. Platelets 2011;22:179–87.10.3109/09537104.2010.543710Search in Google Scholar PubMed
23. Vívenes M, Castro de Guerra D, Rodríguez-Larralde A, Arocha-Piňango CL, Guerrero B. Activity and levels of factor XIII in a Venezuelan admixed population: association with rs5985 (Val35Leu) and STR F13A01 polymorphisms. Thromb Res 2012;130:729–34.10.1016/j.thromres.2012.07.027Search in Google Scholar PubMed
24. Giannini S, Mezzasoma AM, Leone M, Gresele P. Laboratory diagnosis and monitoring of desmopressin treatment of von Willebrand’s disease by flow cytometry. Haematologica 2007;92:1647–54.10.3324/haematol.11313Search in Google Scholar PubMed
25. Daniel WW. Biostatistics: a foundation for analysis in the health science, 7th ed. Hoboken, NJ: John Wiley & Sons, 1999.Search in Google Scholar
26. Van Hylckama Vlieg A, Komanasin N, Ariëns RA, Poort SR, Grant PJ, Bertina RM, et al. Factor XIII Val34Leu polymorphism, factor XIII antigen levels and activity and the risk of deep venous thrombosis. Br J Haematol 2002;119:169–75.10.1046/j.1365-2141.2002.03797.xSearch in Google Scholar PubMed
27. Gresele P, Harrison P, Bury L, Falcinelli E, Gachet C, Hayward CP, et al. Diagnosis of suspected inherited platelet function disorders: results of a worldwide survey. J Thromb Haemost 2014;12:1562–9.10.1111/jth.12650Search in Google Scholar PubMed
28. Gresele P; The Subcommittee on Platelet Physiology. Diagnosis of inherited platelet function disorders: guidance from the SSC of the ISTH. J Thromb Haemost 2015;13:314–22.10.1111/jth.12792Search in Google Scholar PubMed
29. Rodeghiero F, Castaman G, Dini E. Epidemiological investigation of the prevalence of von Willebrand’s disease. Blood 1987;69:454–9.10.1182/blood.V69.2.454.454Search in Google Scholar
30. 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;8:2063–5.10.1111/j.1538-7836.2010.03975.xSearch in Google Scholar PubMed
31. Pitts JF, Jardine AG, Murray SB, Barker NH. Spontaneous subconjunctival haemorrhage – a sign of hypertension? Br J Ophthalmol 1992;76:297–9.10.1136/bjo.76.5.297Search in Google Scholar PubMed PubMed Central
32. Lowe GC, Lordkipanidze M, Watson SP; UK GAPP Study group. Utility of the ISTH bleeding assessment tool in predicting platelet defects in participants with suspected inherited platelet function disorders. J Thromb Haemost 2013;11:1663–8.10.1111/jth.12332Search in Google Scholar PubMed PubMed Central
33. Bidlingmaier C, Grote V, Budde U, Olivieri M, Kurnik K. Prospective evaluation of a pediatric bleeding questionnaire and the ISTH bleeding assessment tool in children and parents in routine clinical practice. J Thromb Haemost 2012;10:1335–41.10.1111/j.1538-7836.2012.04775.xSearch in Google Scholar PubMed
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