Consider a bleeding disorder (Table 102.1) in the patient with spontaneous, prolonged or disproportionate bleeding.
Drugs are the commonest cause of an acquired bleeding disorder.
Priorities⬆⬇
Make a clinical assessment and take a detailed drug history. Is there a known inherited disorder, past or family history of abnormal bleeding?
If the patient has had previous significant injury, surgery, tooth extraction or childbirth without abnormal bleeding, an inherited disorder of haemostasis is unlikely.
Check a full blood count, blood film and coagulation screen (including fibrinogen level): see Chapter 100 for interpretation of full blood count and film; interpretation of the coagulation screen is summarized in Table 102.2. Check renal and liver function. Other investigations will be determined by the clinical context.
Further Management⬆⬇
Further management is directed at the underlying disorder. Seek expert advice from a haematologist on management and haemostatic support, particularly in the event of unexplained bleeding, positive family history, prior bleeding and for help with blood product support.
Clinical features and management of disseminated intravascular coagulation, thrombotic thrombocytopenic purpura and heparin-induced thrombocytopenia are summarized in Appendices 102.1–102.3.