From the Guidelines
Mucocutaneous bleeding is exemplified by nosebleeds (epistaxis), as highlighted in a 2020 clinical practice guideline on nosebleed management 1. This type of bleeding occurs at the junction between mucous membranes and skin, and nosebleeds are a common manifestation. According to the guideline, the clinician should distinguish the nosebleed patient who requires prompt management from bleeding and guide further management in patients with recurrent nasal bleeding, despite prior treatment with packing or other methods 1. Key characteristics of mucocutaneous bleeding include:
- Bleeding that occurs at the mucocutaneous junction
- Common examples include nosebleeds, gum bleeding, and menorrhagia
- Often associated with platelet disorders or medication effects from anticoagulants or antiplatelet drugs
- Typically presents as superficial bleeding rather than deep tissue or joint bleeding The guideline emphasizes the importance of evaluating and managing patients with nosebleeds, including assessing for underlying conditions such as nasal telangiectasias or oral mucosal telangiectasias, and using appropriate interventions such as topical vasoconstrictors, nasal cautery, and moisturizing or lubricating agents 1. In the context of mucocutaneous bleeding, it is essential to consider the potential underlying causes, such as platelet disorders or medication effects, and to guide treatment accordingly. The 2020 guideline provides a comprehensive approach to managing nosebleeds, which can serve as a model for addressing other types of mucocutaneous bleeding 1.
From the FDA Drug Label
Hemophilia A- for patients with factor VIII coagulant activity levels greater than 5% to maintain hemostasis during surgical procedures and postoperatively or reduce bleeding with episodes of spontaneous or traumatic injuries such as hemarthroses, intramuscular hematomas, or mucosal bleeding. von Willebrand's disease (Type I) - for patients with mild to moderate disease with factor VIII levels greater than 5% to maintain hemostasis during surgical procedures or traumatic injuries such as hemarthroses, intramuscular hematomas, or mucosal bleeding.
An example of mucocutaneous bleeding is mucosal bleeding, which includes bleeding from the mucous membranes, such as those found in the nose, mouth, and gastrointestinal tract 2.
From the Research
Mucocutaneous Bleeding
Mucocutaneous bleeding is characterized by bleeding from the skin and mucous membranes. Examples of mucocutaneous bleeding include:
- Epistaxis (nosebleeds) 3, 4
- Easy bruising 3, 4
- Oral cavity bleeding 3
- Menorrhagia (heavy menstrual bleeding) 3, 5, 4
- Postpartum bleeding 5, 4
- Bleeding after dental extraction, surgery, and/or childbirth 3
von Willebrand Disease
von Willebrand disease is a common inherited bleeding disorder that is characterized by excessive mucocutaneous bleeding 3, 5, 6, 4. The disease is caused by quantitative or qualitative defects in von Willebrand factor (VWF), a protein that plays a critical role in blood clotting. The symptoms of von Willebrand disease can vary in severity and frequency, but common manifestations include:
- Nosebleeds 3, 4
- Bruising 3, 4
- Bleeding from minor wounds 4
- Menorrhagia or postpartum bleeding in women 3, 5, 4
- Bleeding after surgery 3
Diagnosis and Treatment
Diagnosis of von Willebrand disease requires specialized assays of VWF and/or molecular genetic testing of the VWF gene 3, 4. Treatment of bleeding episodes in von Willebrand disease includes increasing endogenous VWF levels with desmopressin or infusion of exogenous VWF concentrates (plasma-derived or recombinant) 3, 6, 4. Fibrinolytic inhibitors, topical haemostatic agents, and hormonal therapies are used as effective adjunctive measures 4.