Review Article

Control of Bleeding in Endoscopic Skull Base Surgery: Current Concepts to Improve Hemostasis

Table 1

Various causes of bleeding tendency.

ComponentsCauses

VascularInherited Disorder
 (i) Hereditary hemorrhagic telangiectasia
 (ii) Ehlers-Danlos syndrome
Autoimmune disorder
  Allergic purpura
Reduce the integrity of the blood vessel wall
 (i) Advanced age
 (ii) Prolonged steroid use
 (iii) Vitamin C deficiency

PlateletsChronic diseases
 (i) Kidney failure
 (ii) Liver disease: hepatitis, cirrhosis, and liver failure
 (iii) Splenic sequestration
 (iv) Hematologic malignancy: leukemia, lymphoma, and multiple myeloma
 (v) Bone marrow diseases
 (vi) Human immunodeficiency virus/acquired immunodeficiency syndrome
 (vii) Rare autosomal recessive disorders (Glanzmann’s thrombasthenia and Bernard-Soulier syndrome)
Autoimmune diseases
 (i) Idiopathic thrombocytopenic purpura
 (ii) Systemic lupus erythematosus
Medications
 (i) Antiplatelet: aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs)
 (ii) Antibiotic including penicillin, quinine, and sulfa
Dietary supplements
  Vitamin E, fish oil, Echinacea, Aloe, Ginkgo, Ginseng, and garlic extract

Coagulation factorsInherited disorder
 (i) von Willebrand’s disease
 (ii) Hemophilia
 (iii) Other inherited clotting factor deficiencies (factors II, V, VII, X, and XII)
Medications
 (i) Warfarin (coumadin), heparin
 (ii) Chemotherapies
 (iii) Vitamin K deficiency
Other disorders
 (i) Autoimmune disorders
 (ii) Disseminated intravascular coagulation (also results in thrombocytopenia)
 (iii) Liver disease