Muscle bleeding

Introduction Muscle bleeding occurs because it is pulled too much or is directly hit, causing muscle fiber to tear, blood vessels rupture, and oozing out of the blood vessels, causing intramuscular bleeding. It belongs to the category of soft tissue damage. Muscle bleeding is a clinical manifestation of hemophilia. Hemophilia is a group of congenital coagulation factors that cause bleeding disorders. Congenital factor VIII deficiency is a typical sexual recessive inheritance, transmitted by women, male onset, and the gene that controls the synthesis of factor VIII coagulation components is located on the X chromosome.

Cause

Muscle bleeding is a clinical manifestation of hemophilia. Hemophilia is a group of congenital coagulation factors that cause bleeding disorders. Congenital factor VIII deficiency is a typical sexual recessive inheritance, transmitted by women, male onset, and the gene that controls the synthesis of factor VIII coagulation components is located on the X chromosome. The sick male is married to the normal female, the male is normal in the child, the female is the passer; the normal male and the female in the passer are married, half of the male is the patient, and half of the female is the passer; the male and the female are married and the female is born. Half of the boys have hemophilia, and half of the girls born are hemophilia, and half of them are transmitters. About 30% have no family history, and its onset may be caused by genetic mutations. Factor IX lacks the same genetic pattern as hemophilia A, but female transmitters have lower levels of factor IX and have a tendency to bleed. The lack of factor X1 leads to the formation of blood thromboplastin. Prothrombin cannot be converted to thrombin. Fibrinogen cannot be converted to fibrin and is prone to bleeding.

an examination

Related inspection

Electromyography blood routine clotting factor activity determination platelet adhesion test

Bleeding is the main clinical manifestation of this disease. Patients have spontaneous/slight injury/long-term bleeding tendency after surgery. Heavy-duration can occur both after birth and milder.

1. Skin and mucous membrane bleeding is easy to be injured due to subcutaneous tissue, gums, tongue, oral mucosa and other parts, so it is a bleeding site. Children are more likely to have hemorrhage/hematoma after frontal collision, but skin and mucous membrane bleeding is not a feature of this disease.

2. Joint blood: It is a common clinical manifestation of hemophilia A patients. It often occurs during trauma/walking/exercise and causes synovial hemorrhage, which is more common in the knee joint, followed by sacral, hip, elbow, shoulder and wrist joints. Wait. Joint bleeding can be divided into three phases:

A. Acute phase: bleeding in the joint cavity and around the joint tissue, causing local fever, redness and pain in the joint. Following the muscle spasm, limited mobility, the joints are mostly in the flexion position.

B. Total arthritis: In most cases, blood is not completely absorbed due to repeated bleeding. The enzyme released by white blood cells and other components in the blood stimulate joint tissues to form chronic inflammation and thickening of the synovium.

C. Late stage: joint fibrosis / joint stiffness, deformity, muscle atrophy, bone destruction, joint contracture leading to loss of function. Repeated bleeding of the knee joint often causes knee flexion, valgus, and subluxation of the tibia, forming a characteristic hemophilia pace.

3. Muscle hemorrhage and hematoma often occur in severe hemophilia A, which occurs more often after trauma/muscle activity, and is more common in forced muscle groups.

4. Hematuria: Patients with severe hemophilia A may have microscopic hematuria or gross hematuria, no pain, no history of trauma. However, if there is a ureteral clot, there is a symptom of renal colic.

5. Pseudo-tumor (hemophilic blood cysts) cysts can occur in any part, more common in the thighs, pelvis, calves, feet, arms and hands, and sometimes in the eyes.

6. Post-traumatic or post-surgical bleeding Various degrees of trauma, minor surgery can cause long-lasting and slow bleeding or bleeding.

7. Other parts of the bleeding gastrointestinal bleeding can be manifested as hematemesis, melena, bloody stools or abdominal pain, most patients have primary lesions such as stomach, duodenal ulcer; hemoptysis is related to tuberculosis, branch expansion and other primary lesions; Hemorrhoids and sublingual hematoma are usually caused by oral damage in patients with hemophilia A; sublingual hematoma can cause tongue displacement. If hematoma develops into the neck, it often causes difficulty in breathing; intracranial hemorrhage is often the cause of death of hemophilia patients.

8. Compression symptoms caused by bleeding and its complications Hematoma compression nerves, can lead to numbness, loss of sensation, severe pain, muscle atrophy, etc. in the compressed nerve innervation; tongue, oral bottom, tonsil, posterior pharyngeal wall, anterior neck hemorrhage , can cause upper airway obstruction, leading to difficulty breathing, and even suffocation, local blood vessels are compressed, can cause tissue necrosis.

The criteria for clinical diagnosis are:

A. Mostly male patients (female homozygotes are rare), with or without family history, family history with x-linked recessive inheritance.

B. Joint, muscle, deep tissue hemorrhage, with or without active activity, exertion, trauma or abnormal bleeding history after surgery, severe deformity can be seen.

C. The laboratory test results are positive.

Differential diagnosis

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