Last updated: Thursday, 11, November, 2010
|Acquired and inherited causes||Appropriate Tests|
Note site and nature of bleeding; presence and duration of previous history of surgical, dental, joint, menstrual, mucosal, and skin bleeding; presence of underlying disorder, or use of drugs associated with risk of bleeding. Assess whether bleeding is spontaneous, or inappropriate and/or excessive in relation to trauma.
Assess initially with FBC, PT / INR, APTT, blood film, platelet count, where bleeding is thought to be pathological.
Additional laboratory testing may be indicated by history or the initial test results.
|Acquired bleeding disorders|
Advanced and/or metastatic carcinoma
|See under Carcinoma.|
Blood transfusion related
|See under Blood transfusion.|
See under DIC
Drug-related bleeding, especially
|See Anticoagulant monitoring.|
|See Thrombolytic therapy.|
|Predictable abnormality of bleeding time and platelet aggregation; these tests do not predict the risk of bleeding and are not indicated.|
|See Bleeding under Cirrhosis - consequences.|
Myeloproliferative disorders, especially
Obstetric (peripartum) bleeding
|See under Pregnancy.|
|See Bleeding under Renal failure - chronic (complications).|
|See under Poisoning.|
Inherited bleeding disorders
There is usually a personal and/or family history of bleeding.
Von Willebrand's disase is the most common bleeding disorder. The high incidence is not limited to certain ethnic groups. Mild disorders may present as minor injury or post trauma/surgery bleeding, especially Von Willebrand's disease. Further, Haemophilia A is the second most common inherited coagulopathy.
Initially - FBC, platelet count, blood film; PT/INR, APTT and Factor VIII assay.
Normal results do not exclude the possibility of a clinically significant inherited bleeding disorder. Further investigation should be determined on the basis of the history. Further tests may be indicated from the initial results and, as appropriate, from the history and the degree of clinical suspicion.
The bleeding time is not an effective screening test and a normal BT does not exclude a bleeding disorder.
|See under Haemophilia.|
|See under Haemophilia.|
Factor XI deficiency
|Coagulation factors (XI) assay.|
Factor XII deficiency
|Coagulation factors (XII) assay; this deficiency is not associated with an increased risk of bleeding.|
Factor XIII deficiency
|Factor XIII screening test; consult pathologist.|
|Thrombin time, fibrinogen assay.|
|Thrombin time, reptilase time; consult pathologist.|
Inherited disorders of platelet function, including
|A platelet function screen (PFA-100) may suggest a platelet function disorder. Consult pathologist.|
Platelet aggregation/release studies. For definitive platelet membrane, granule, and prostaglandin studies - consult pathologist.
Hereditary haemorrhagic telangiectasia
Clinical diagnosis. Mucocutaneous telangiectases with recurrent bleeding from mucosal surfaces. See also Telangiectases