Medication Summary

The use of antifibrinolytic agents and synthetic antidiuretic hormones may be indicated.

Class Summary

Antifibrinolytic agents decrease bleeding and transfusion requirements and help establish hemostasis. They are especially useful for controlling bleeding or prolonged oozing from gingival surfaces (eg, during teething in infants).

Aminocaproic acid (Amicar)

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Competitively inhibits activation of plasminogen to plasmin.

Tranexamic acid (Cyklokapron)

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Competitively inhibits activation of plasminogen to plasmin.

Class Summary

Synthetic antidiuretic hormones nonspecifically enhance hemostasis by stimulating the release of von Willebrand factor. Desmopressin stimulates the release of factor VIII, prostaglandins, and plasminogen. However, the mechanism of action is not clear, and it may not be common to all 3 substances. These agents affect vascular walls, increasing platelet adhesion. This local hemostatic action may account for their hemostatic properties.

Desmopressin acetate (DDAVP)

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Increases plasma factor VIII levels, promoting platelet aggregation. Intranasal route not recommended because of unproven efficacy in small infants. Only concentrated form (150 mcg/spray) enhances hemostasis.

Follow-up

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Media Gallery

Infant with thrombocytopenia-absent radius syndrome. The arms and forearms are shortened, with radial deviation of both hands because of the absence of bilateral radii. The legs are normal. See also Media files 2 and 3.
Same infant as in Media files 1 and 3. Close-up photograph of arm and forearm (volar aspect). Note the petechiae.
Same infant as in Media files 1 and 2. Close-up photograph of arm and forearm (dorsal aspect).

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Author

John K Wu, MBBS, MSc, FRCPC Clinical Professor, Department of Pediatrics, Division of Hematology-Oncology-BMT, University of British Columbia Faculty of Medicine, British Columbia Children's Hospital, Canada

John K Wu, MBBS, MSc, FRCPC is a member of the following medical societies: American Society of Hematology, International Society on Thrombosis and Haemostasis, Canadian Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher Wu, MD Resident Physician, Department of Urology, McMaster University School of Medicine, Canada

Christopher Wu, MD is a member of the following medical societies: American Urological Association, Canadian Urological Association

Disclosure: Nothing to disclose.

Michelle P Wong, MD Staff Physician, Department of Hematopathology, University of British Columbia Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Suzan Williams, MD, MSc, FRCPC Staff Physician, Division of Hematology, The Hospital for Sick Children, Canada

Suzan Williams, MD, MSc, FRCPC is a member of the following medical societies: American Academy of Pediatrics, American Society of Hematology, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Paediatric Society, College of Physicians and Surgeons of Ontario, Ontario Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

James L Harper, MD Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Associate Clinical Professor, Department of Pediatrics, Creighton University School of Medicine; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center

James L Harper, MD is a member of the following medical societies: American Society of Pediatric Hematology/Oncology, American Federation for Clinical Research, Council on Medical Student Education in Pediatrics, Hemophilia and Thrombosis Research Society, American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology

Disclosure: Nothing to disclose.

Chief Editor

Hassan M Yaish, MD Medical Director, Intermountain Hemophilia and Thrombophilia Treatment Center; Professor of Pediatrics, University of Utah School of Medicine; Director of Hematology, Pediatric Hematologist/Oncologist, Department of Pediatrics, Primary Children's Medical Center

Hassan M Yaish, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Michigan State Medical Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

J Martin Johnston, MD Associate Professor of Pediatrics, Mercer University School of Medicine; Director of Hematology/Oncology, The Children's Hospital at Memorial University Medical Center; Consulting Oncologist/Hematologist, St Damien's Pediatric Hospital

J Martin Johnston, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, International Society of Paediatric Oncology

Disclosure: Nothing to disclose.