Description:

This session will focus on challenging bleeding in acquired bleeding disorders. The discussion will involve the identification and management of bleeding in the aging population, in refractory ITP and in patients with underlying liver dysfunction.

Dr. Rebecca Kruse Jarres will examine challenges with acquired bleeding disorders in the elderly. She will describe physiologic changes affecting coagulation as we age and describe the particular challenge in treating acquired bleeding disorders in this setting. The discussion will focus on bleeding disorders caused by certain drugs, in light of the aging physiology, as well as acquired impairment of clotting proteins such as factor VIII and von Willebrand factor.

Dr. Donald Arnold will review the bleeding complications in patients with immune thrombocytopenia (ITP) and examine the use of bleeding as a clinical endpoint in ITP trials. He will provide a practical approach to the patient with refractory ITP including emergency management of severe bleeding, and outpatient treatment algorithms.

Dr. Jody Kujovich will review the complex changes in hemostasis that occur in liver disease with a focus on chronic liver disease. She will discuss evidence for the concept of rebalanced hemostasis due to the parallel reduction in anticoagulant as well as procoagulant factors. She will discuss limitations of conventional laboratory tests for the evaluation of bleeding and bleeding risk and update the role of newer global assays of hemostasis (thrombin generation assay and thromboelastography (TEG)). She will then describe strategies for prevention and treatment of bleeding complications.