B83 Purpura/coagulation defect (ICD-10:D69.9, D68.9)

Introduction

Purpura/coagulation defect refers to a heterogeneous group of conditions characterized by abnormal bleeding due to disorders affecting the coagulation cascade, platelet function, or vascular integrity^[1]. Purpura manifests as purple or red discoloration of the skin caused by bleeding into tissues from capillaries and small blood vessels^[2]. These conditions can range from benign senile purpura to life-threatening disorders such as thrombotic thrombocytopenic purpura (TTP) or purpura fulminans^[3]. This comprehensive guide provides an evidence-based approach to diagnosing and managing patients with purpura and coagulation defects.

Codes

• ICPC-2 Code: B83 Purpura/coagulation defect
• ICD-10 Codes: D69.9 Hemorrhagic condition, unspecified; D68.9 Coagulation defect, unspecified^[4]

Symptoms

The clinical presentation varies significantly based on the underlying cause and severity of the coagulation defect^[2]:

Cutaneous Manifestations

• Petechiae: Small (1-3 mm), pinpoint red or purple spots that do not blanch with pressure, typically indicating thrombocytopenia^[5]
• Purpura: Larger purple patches (3-10 mm) caused by bleeding into the skin^[2]
• Ecchymoses: Larger areas of bruising (>10 mm) that may change color over time^[5]
• Easy bruising: Bruising with minimal trauma or spontaneous bruising^[6]

Bleeding Manifestations

• Mucosal bleeding: Including epistaxis (nosebleeds), gingival bleeding, and menorrhagia^[7]
• Prolonged bleeding: From minor cuts, dental procedures, or surgical sites^[6]
• Gastrointestinal bleeding: May present as hematemesis, melena, or hematochezia^[7]
• Genitourinary bleeding: Hematuria or excessive menstrual bleeding^[6]

Systemic Symptoms

• Fatigue and weakness: Often related to anemia from chronic bleeding^[8]
• Joint pain and swelling: Hemarthrosis in patients with coagulation factor deficiencies^[9]
• Fever: May indicate underlying infection or autoimmune condition^[10]

Emergency Presentations

• Purpura fulminans: Rapidly progressive skin necrosis with disseminated intravascular coagulation^[3]
• Intracranial hemorrhage: Life-threatening complication requiring immediate intervention^[11]

Causes

The etiology of purpura and coagulation defects can be broadly categorized^[12]:

Inherited Coagulation Disorders

• Hemophilia A and B: Factor VIII and IX deficiencies, respectively, affecting 1 in 5,000-10,000 males^[9]
• Von Willebrand disease: Most common inherited bleeding disorder, affecting up to 1% of the population^[13]
• Factor deficiencies: Rare deficiencies of factors II, V, VII, X, XI, XII, and XIII
• Platelet function disorders: Including Glanzmann thrombasthenia and Bernard-Soulier syndrome

Acquired Coagulation Disorders

• Liver disease: Reduced synthesis of coagulation factors and altered platelet function^[14]
• Vitamin K deficiency: Affects factors II, VII, IX, and X synthesis^[15]
• Disseminated intravascular coagulation (DIC): Consumption of clotting factors and platelets^[16]
• Acquired hemophilia: Autoantibodies against factor VIII, with incidence of 1.48 per million per year^[17]

Thrombocytopenic Causes

• Immune thrombocytopenic purpura (ITP): Autoimmune destruction of platelets with incidence of 3.3 per 100,000 adults annually^[18]
• Thrombotic thrombocytopenic purpura (TTP): Rare disorder with mortality >90% if untreated^[19]
• Medication-induced: Including heparin-induced thrombocytopenia and quinidine-induced thrombocytopenia
• Hypersplenism: Sequestration and destruction of platelets in enlarged spleen

Vascular Causes

• Senile purpura: Age-related capillary fragility affecting up to 12% of those over 50^[2]
• Vasculitis: Inflammation of blood vessels causing bleeding and purpura
• Scurvy: Vitamin C deficiency leading to capillary fragility^[20]
• Hereditary hemorrhagic telangiectasia: Genetic disorder causing vascular malformations

Diagnostic Steps

Medical History

Comprehensive history should focus on^[21]:

• Family history: Inherited bleeding disorders, particularly in male relatives
• Bleeding pattern: Mucosal bleeding suggests platelet disorders; deep tissue/joint bleeding suggests coagulation factor deficiencies
• Medication history: Anticoagulants, antiplatelet agents, NSAIDs, antibiotics
• Associated symptoms: Fever, weight loss, joint pain, organomegaly
• Surgical/dental history: Previous bleeding complications or transfusion requirements
• Menstrual history: Heavy menstrual periods may indicate underlying bleeding disorder

Physical Examination

Systematic examination should include^[22]:

• Skin assessment: Distribution and characteristics of purpura, petechiae, or ecchymoses
• Lymph node examination: Generalized lymphadenopathy may suggest hematologic malignancy
• Spleen and liver palpation: Organomegaly may indicate underlying systemic disease
• Joint examination: Evidence of hemarthrosis or chronic arthropathy
• Mucous membrane assessment: Oral, nasal, and conjunctival bleeding
• Fundoscopic examination: Retinal hemorrhages may indicate severe thrombocytopenia

Laboratory Tests

Initial Coagulation Studies

• Complete blood count (CBC) with platelet count: Essential first step; normal platelet count is 150,000-450,000/µL^[23]
• Prothrombin time (PT/INR): Assesses extrinsic pathway (factors II, V, VII, X)^[24]
• Activated partial thromboplastin time (aPTT): Evaluates intrinsic pathway (factors VIII, IX, XI, XII)^[24]
• Peripheral blood smear: Morphologic evaluation of platelets and blood cells
• Fibrinogen level: Decreased in DIC or congenital afibrinogenemia

Specialized Coagulation Testing

• Von Willebrand studies: VWF antigen, activity (ristocetin cofactor), and multimers^[25]
• Factor assays: Specific factor levels when hereditary deficiency suspected
• Mixing studies: Distinguish factor deficiency from inhibitors
• Platelet function testing: Including platelet aggregometry when indicated
• D-dimer and fibrin degradation products: Elevated in DIC or fibrinolysis

Additional Laboratory Studies

• Liver function tests: AST, ALT, bilirubin, albumin to assess hepatic synthesis^[26]
• Renal function: Creatinine and BUN, as uremia can affect platelet function
• Autoimmune markers: ANA, anti-dsDNA for systemic lupus erythematosus
• Viral studies: Hepatitis B/C, HIV, CMV, EBV when clinically indicated
• Vitamin levels: B12, folate, vitamin K status

Diagnostic Imaging

• Abdominal ultrasonography: Assess spleen size and detect organomegaly^[27]
• CT or MRI: For suspected internal bleeding or organ involvement
• Echocardiography: When endocarditis suspected as cause of bleeding

Specialized Testing

• Bone marrow examination: When hematologic malignancy or primary bone marrow disorder suspected^[28]
• Genetic testing: For confirmed or suspected inherited bleeding disorders
• ADAMTS13 activity: Essential for TTP diagnosis; activity <10% diagnostic^[19]

Possible Interventions

Traditional Medical Interventions

Targeted Therapies Based on Underlying Cause

1. Desmopressin (DDAVP)

• Indications: Mild hemophilia A, von Willebrand disease type 1, and platelet function disorders^[29]
• Mechanism: Increases factor VIII and von Willebrand factor release from endothelial cells
• Dosing: 0.3 µg/kg IV/SC or 300 µg intranasal
• Cost: $50-100 per vial^[30]
• Side effects: Headache, nausea, facial flushing
• Severe side effects: Hyponatremia, seizures, water intoxication^[31]
• Monitoring: Serum sodium levels, especially with repeated doses

2. Antifibrinolytic Agents

• Tranexamic acid: Most commonly used antifibrinolytic agent
• Mechanism: Inhibits plasminogen activation, stabilizing clots
• Dosing: 15-25 mg/kg IV every 8 hours or 1-1.5g orally 2-3 times daily
• Cost: $10-50 per month^[32]
• Contraindications: Active thromboembolism, subarachnoid hemorrhage, acquired defective color vision^[33]
• Side effects: Nausea, diarrhea, dizziness
• Severe side effects: Thromboembolic events, seizures (with intrathecal administration)

3. Immunosuppressive Therapies

• Corticosteroids: First-line treatment for ITP and autoimmune causes
• Prednisone dosing: 1-2 mg/kg/day initially, then tapered
• Cost: $10-50 per month for generic formulations^[34]
• Side effects: Weight gain, hyperglycemia, mood changes, increased infection risk
• Rituximab: Anti-CD20 monoclonal antibody for refractory ITP
• Dosing: 375 mg/m² weekly for 4 weeks
• Response rate: 60-70% in ITP patients^[35]

4. Intravenous Immunoglobulin (IVIG)

• Indications: ITP, post-transfusion purpura, acquired hemophilia^[36]
• Mechanism: Blocks Fc receptors, reduces platelet destruction
• Dosing: 1-2 g/kg divided over 2-5 days
• Cost: $500-2,000 per infusion^[37]
• Response rate: 90% in post-transfusion purpura^[36]
• Side effects: Headache, fever, chills
• Severe side effects: Anaphylaxis, renal failure, thrombosis

5. Coagulation Factor Concentrates

• Factor VIII concentrates: For hemophilia A and acquired hemophilia
• Factor IX concentrates: For hemophilia B
• Prothrombin complex concentrates: For multiple factor deficiencies
• Recombinant factors: Preferred due to reduced viral transmission risk
• Cost: $2-5 per unit, with treatment costs ranging $200,000-400,000 annually for severe hemophilia^[38]

Emergency Interventions

For Life-Threatening Bleeding

• Platelet transfusion: 1 unit per 10 kg body weight increases platelet count by ~50,000/µL^[39]
• Fresh frozen plasma: Contains all coagulation factors; typical dose 10-15 mL/kg
• Cryoprecipitate: Rich in fibrinogen, factor VIII, and von Willebrand factor
• Prothrombin complex concentrates: For rapid reversal of warfarin or multiple factor deficiencies

For TTP

• Plasma exchange: First-line treatment with mortality reduction from >90% to <20%^[19]
• Immunosuppression: Corticosteroids, rituximab for refractory cases
• Caplacizumab: Anti-von Willebrand factor antibody for acquired TTP

Surgical Interventions

Splenectomy

• Indications: Refractory ITP, hypersplenism, certain hemolytic anemias^[40]
• Response rate: 50-70% durable response in ITP^[40]
• Approaches: Laparoscopic preferred when feasible
• Cost: $15,000-40,000 depending on approach and complications^[41]
• Complications: Post-splenectomy sepsis risk (1-5%), thrombosis risk
• Long-term management: Lifelong vaccination protocols, antibiotic prophylaxis

Other Surgical Procedures

• Joint replacement: For chronic hemophilic arthropathy
• Arterial embolization: For life-threatening hemorrhage
• Surgical bleeding control: Direct intervention for accessible bleeding sites

Alternative and Complementary Interventions

Evidence-Based Approaches

While conventional medical treatment remains primary, some supportive approaches may be beneficial:

• Vitamin C supplementation: For confirmed deficiency causing capillary fragility^[20]
• Iron supplementation: For iron deficiency anemia secondary to chronic bleeding
• Dietary modifications: Avoiding alcohol in liver disease, adequate nutrition

Unproven or Potentially Harmful Therapies

• Herbal supplements: Many herbs (ginkgo, garlic, ginger) have antiplatelet effects and should be avoided^[42]
• Hyperbaric oxygen therapy: No proven benefit for bleeding disorders; expensive ($200-300 per session)^[43]
• Chelation therapy: Not indicated for bleeding disorders; potential for serious side effects
• Homeopathic remedies: No scientific evidence supporting efficacy in bleeding disorders

Lifestyle Interventions

Activity Modifications

• Contact sport restrictions: Particularly important for patients with severe bleeding disorders^[44]
• Protective equipment: Helmets, padding for high-risk activities
• Activity level: Encourage appropriate physical activity while avoiding high-risk situations
• Occupational considerations: Modify work activities that pose bleeding risk

Medication Management

• Avoid antiplatelet agents: Aspirin, NSAIDs unless specifically indicated^[45]
• Anticoagulant caution: Careful risk-benefit analysis for atrial fibrillation or thrombosis
• Drug interaction awareness: Many medications affect hemostasis
• Medical alert identification: Bracelet or card identifying bleeding disorder

Dietary and General Health Measures

• Balanced nutrition: Adequate protein for clotting factor synthesis
• Alcohol moderation: Alcohol impairs platelet function and liver synthesis
• Dental hygiene: Regular dental care to prevent gingival bleeding
• Weight management: Reduce joint stress in hemophilia patients
• Smoking cessation: Improves vascular health and wound healing

Emergency Preparedness

• Action plan: Written instructions for bleeding episodes
• Medical contact information: 24-hour access to hematologist
• Medication availability: Emergency supplies of factor concentrates or other specific treatments
• Hospital identification: Pre-registered at treatment centers when possible

Follow-up and Patient Education

Monitoring Schedule

• Acute phase: Daily to weekly monitoring until bleeding controlled and underlying cause addressed
• Stable patients: Every 3-6 months with laboratory studies as indicated
• Medication monitoring: Regular assessment for treatment response and side effects
• Long-term surveillance: Annual comprehensive evaluations for chronic conditions

Patient Education Priorities

• Recognition of bleeding: Early signs requiring medical attention
• Medication compliance: Importance of prophylactic factor replacement in severe hemophilia
• Activity guidelines: Safe participation in sports and activities
• Emergency management: When to seek immediate care, use of emergency medications
• Family planning: Genetic counseling for inherited disorders
• Vaccination: Importance of hepatitis A/B vaccines, annual influenza vaccine

When to Seek Emergency Care

• Severe bleeding: Heavy, uncontrolled bleeding not responsive to usual measures
• Head trauma: Any significant head injury in bleeding disorder patients
• Neurological symptoms: Headache, confusion, weakness suggesting intracranial bleeding
• Abdominal pain: Particularly severe or with associated bleeding
• Fever and bleeding: May indicate serious infection or TTP

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – B83 Purpura/coagulation defect (ICD-10:D69.9, D68.9)

Mild	Moderate	Severe
Mode setting: 1 (Infection) Location: 3 (Kidney, Liver & Spleen) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 1 (Infection) Location: 3 (Kidney, Liver & Spleen) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 1 (Infection) Location: 3 (Kidney, Liver & Spleen) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Mode setting: 2 (Wound Healing) Location: 3 (Kidney, Liver & Spleen) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 2 (Wound Healing) Location: 3 (Kidney, Liver & Spleen) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 2 (Wound Healing) Location: 3 (Kidney, Liver & Spleen) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Mode setting: 7 (Immunotherapy) Location: 7 (Neuro system & ENT) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 7 (Immunotherapy) Location: 7 (Neuro system & ENT) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 7 (Immunotherapy) Location: 7 (Neuro system & ENT) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Total Morning: 45 minutes approx. $7.50 USD, Evening: 45 minutes approx. $7.50 USD	Total Morning: 90 minutes approx. $15 USD, Lunch: 90 minutes approx. $15 USD, Evening: 90 minutes approx. $15 USD	Total Morning: 90 minutes approx. $15 USD, Lunch: 90 minutes approx. $15 USD, Evening: 90 minutes approx. $15 USD
Usual treatment for 7-60 days approx. $105 USD – $900 USD	Usual treatment for 6-8 weeks approx. $1,890 USD – $2,520 USD	Usual treatment for 3-6 months approx. $4,050 USD – $8,100 USD

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Purpura/coagulation defect effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Purpura/coagulation defect. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Cleveland Clinic. Thrombotic Thrombocytopenic Purpura (TTP). 2025. Available from: https://my.clevelandclinic.org/health/diseases/22380-thrombotic-thrombocytopenic-purpura
2. Medical News Today. Purpura: Causes, pictures, and symptoms. 2023. Available from: https://www.medicalnewstoday.com/articles/311725
3. Chalmers E, et al. Purpura fulminans: recognition, diagnosis and management. Archives of Disease in Childhood. 2011. Available from: https://pubmed.ncbi.nlm.nih.gov/21233082/
4. World Health Organization. International Classification of Diseases, 10th Revision (ICD-10). Geneva: WHO Press; 2019.
5. Healthline. Purpura: Causes, Diagnosis, Treatment, and Pictures. 2018. Available from: https://www.healthline.com/health/purpura
6. Lal Pathlabs. Causes, Symptoms, Diagnosis, and Prevention of Purple Skin Spots. 2024. Available from: https://www.lalpathlabs.com/blog/what-is-purpura/
7. StatPearls. Purpura Fulminans. 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532865/
8. American Society of Hematology. Bleeding Disorders Overview. 2024. Available from: https://www.hematology.org/education/patients
9. National Hemophilia Foundation. Hemophilia A and B Overview. 2024. Available from: https://www.hemophilia.org/bleeding-disorders
10. Mayo Clinic. Thrombocytopenia Symptoms and Causes. 2024. Available from: https://www.mayoclinic.org/diseases-conditions/thrombocytopenia
11. World Federation of Hemophilia. Guidelines for Management of Hemophilia. 2024. Available from: https://www.wfh.org/en/resources/wfh-treatment-guidelines
12. National Center for Biotechnology Information. Coagulation Disorders Overview. 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545263/
13. National Heart, Lung, and Blood Institute. Von Willebrand Disease. 2024. Available from: https://www.nhlbi.nih.gov/health/von-willebrand-disease
14. Revista de Gastroenterología de México. Guidelines for the management of coagulation disorders in patients with cirrhosis. 2024. Available from: http://www.revistagastroenterologiamexico.org/en-guidelines-for-management-coagulation-disorders-avance-S2255534X24000124
15. Mayo Clinic. Vitamin K Deficiency. 2024. Available from: https://www.mayoclinic.org/diseases-conditions/vitamin-k-deficiency
16. StatPearls. Disseminated Intravascular Coagulation. 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441834/
17. Collins PW, et al. Real-world impact of emicizumab and immunosuppression on acquired hemophilia A. Blood. 2024. Available from: https://pubmed.ncbi.nlm.nih.gov/39361769
18. American Society of Hematology. Immune Thrombocytopenic Purpura Guidelines. 2024. Available from: https://www.hematology.org/education/clinicians/guidelines-and-quality-care
19. Cleveland Clinic. Thrombotic Thrombocytopenic Purpura (TTP). 2025. Available from: https://my.clevelandclinic.org/health/diseases/22380-thrombotic-thrombocytopenic-purpura
20. Mayo Clinic. Scurvy. 2024. Available from: https://www.mayoclinic.org/diseases-conditions/scurvy
21. American Society of Hematology. Bleeding Disorder Diagnosis Guidelines. 2024. Available from: https://www.hematology.org/education/clinicians
22. StatPearls. Physical Examination in Bleeding Disorders. 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470199/
23. Mayo Clinic. Complete Blood Count Reference Values. 2024. Available from: https://www.mayocliniclabs.com/test-catalog/overview/9109
24. American Association for Clinical Chemistry. Coagulation Testing. 2024. Available from: https://www.aacc.org/cln/articles/2019/february/coagulation-testing
25. National Heart, Lung, and Blood Institute. Von Willebrand Disease Diagnosis. 2024. Available from: https://www.nhlbi.nih.gov/health/von-willebrand-disease/diagnosis
26. American Association for Study of Liver Diseases. Liver Function Tests. 2024. Available from: https://www.aasld.org/
27. American College of Radiology. Appropriateness Criteria for Bleeding Disorders. 2024. Available from: https://www.acr.org/Clinical-Resources
28. American Society of Hematology. Bone Marrow Examination Guidelines. 2024. Available from: https://www.hematology.org/education/clinicians/guidelines-and-quality-care
29. World Federation of Hemophilia. Desmopressin Guidelines. 2024. Available from: https://www.wfh.org/en/resources/wfh-treatment-guidelines
30. GoodRx. Desmopressin Prices. 2024. Available from: https://www.goodrx.com/desmopressin
31. WebMD. Desmopressin Side Effects and Interactions. 2024. Available from: https://www.webmd.com/drugs/2/drug-12128/desmopressin-oral/details
32. WHO Global Health Supply Chain. Tranexamic Acid Procurement Guidelines. 2022. Available from: https://www.ghsupplychain.org/sites/default/files/2022-11/MNCH%20Commodities%20Procurement-TXA_0.pdf
33. Mayo Clinic. Tranexamic acid Side Effects and Precautions. 2025. Available from: https://www.mayoclinic.org/drugs-supplements/tranexamic-acid-intravenous-route/description/drg-20072465
34. GoodRx. Prednisone Prices and Generic Options. 2024. Available from: https://www.goodrx.com/prednisone
35. American Society of Hematology. Rituximab in ITP Guidelines. 2024. Available from: https://www.hematology.org/education/clinicians/guidelines-and-quality-care
36. Ameripharma Specialty. IVIG for Post-Transfusion Purpura Guide. 2025. Available from: https://ameripharmaspecialty.com/ivig/ivig-for-post-transfusion-purpura-a-comprehensive-guide-to-its-use-and-doses/
37. National Hemophilia Foundation. Treatment Cost Information. 2024. Available from: https://www.hemophilia.org/healthcare-professionals
38. World Federation of Hemophilia. Global Annual Survey Report. 2024. Available from: https://www.wfh.org/en/data-collection
39. American Association of Blood Banks. Platelet Transfusion Guidelines. 2024. Available from: https://www.aabb.org/tm/guidelines
40. Chaturvedi S, et al. Splenectomy for immune thrombocytopenia: down but not out. Blood. 2018. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5855018/
41. Healthcare Cost and Utilization Project. Splenectomy Cost Analysis. 2024. Available from: https://www.hcup-us.ahrq.gov/
42. National Center for Complementary and Integrative Health. Herbs and Bleeding Risk. 2024. Available from: https://www.nccih.nih.gov/
43. Undersea and Hyperbaric Medical Society. Clinical Indications for Hyperbaric Oxygen. 2024. Available from: https://www.uhms.org/
44. National Hemophilia Foundation. Activity Guidelines for Bleeding Disorders. 2024. Available from: https://www.hemophilia.org/community/people-with-bleeding-disorders
45. American College of Cardiology. Antiplatelet Therapy Guidelines. 2024. Available from: https://www.acc.org/guidelines