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Hemorrhagic disturbances abound in clinical confusion. The loss of "life" blood alarms parents, the appearance of petechiae perplexes physicians, and a hemorrhagic history preoperatively petrifies surgeons. The hemorrhagic state is ever a problem. Manifest bleeding is precipitated and yields more readily to immediate control than to subsequent prevention, but latent hemorrhage is elusive, defying detection even more than a diagnostic differentiation. Children reveal hemorrhagic symptomatology that is too heterogeneous to be typical, too recurrent to withstand diagnostic delay, too dependent on systemic disease to be primarily hemorrhagic.1
The hemorrhagic status of a patient is best evaluated clinically in terms of degree of function of the vascular endothelium and its blood content. Although chemical changes are present in both in most hemorrhagic disturbances, the one or the other necessarily dominates the picture. It is only in truly hereditary hemorrhagic disease that absolute deficiency in the vascular system or in one
KUGELMASS IN. THE MANAGEMENT OF HEMORRHAGIC PROBLEMS IN INFANCY AND CHILDHOOD. JAMA. 1932;99(11):895–902. doi:10.1001/jama.1932.02740630021006
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