Definition

Abnormal Bleeding refers to an excessively long bleeding time which also increases the risk of bruising.

History

Site

Where does the bleeding or bruising occur?

Quality

How easily do you bruise?

Severity

How much blood is lost?
How much do you bruise?
How long does it take to stop bleeding?

Time Course

Duration

How long has the bleeding/ bruising been a problem for?

Temporal Profile

Does the bruising/ bleeding problem come and go?
Has it been getting worse?

Context

Can you think of anything that might cause the bleeding/ bruising?

Aggravating Factors

Is there anything that makes it worse?

Relieving Factors

Is there anything that makes it better?

Associated Features

Have you noticed anything else apart from the bleeding/ bruising?
Have you had any of the following:

Past History

Medications

Do you take:

Family History

Does anybody in your family have a bleeding disorder?
Has anybody else in your family had leukaemia or lymphoma?

Social History

  • Can you tell me about you where you live?
  • Where do you work?
  • What are your hobbies?
  • Do you smoke?
  • Do you drink alcohol?

Examinations and Investigations

Bloods



Coagulation Studies


Condition
INR
APTT
Thrombin Time
Platelet Count
Bleeding time
Liver Disease


- or ↑
- or ↓
- or ↑
Reduced Platelet Function
-
-
-
-

Vitamin K deficiency


-
-
-
Haemophilia
-

-
-
-
von Willebrand's Disease
-

-
-

Anticoagulant use



-
-

Imaging

  • CT or MRI of head if there is suspected intracranial bleeding

Differential Diagnosis

Vascular disorder

  • Connective tissue disorders - Ehlers-Danlos syndrome, Hereditary hemorrhagic telangiectasia
  • Infections (acquired) - meningitis, dengue fever, measles, ebola
  • Scurvy (acquired) - gum bleeding
  • Chronic corticosteroid use (acquired) - signs of Cushing's Syndrome

Platelet disorder

See also thrombocytopaenia, pancytopaenia

Decreased Production

Excess Destruction

Reduced function

Coagulation disorder

Red Flags

Management

  • Avoid or reduce dosage of anticoagulant or antiplatelet medications.
  • Stop Bleeding

Non-Pharmacological

  • IV fluids if hypovolaemic
  • Recombinant Factor (if haemophilia)
  • Platelet transfusion
  • Blood transfusion
  • Vitamin K replacement

Pharmacological

  • Discuss Cancer Therapy Options
  • Antibiotics if there is an infection

See also

Bleeding disorders