Evaluation of the Patient With Suspected Bleeding Disorders

Bruising and bleeding problems are common reasons for a hematology referral. Some consults are for management of an acute bleed, whereas other referrals are to evaluate an unexpected bleeding episode or the diagnosis of a bleeding disorder in a family. The assessment of such patients must be individualized and needs to include a detailed history of their current and past bleeding events, family history, and all prescribed and nonprescribed medications. Bleeding symptom assessment is challenging because some minor bleeding symptoms may or may not reflect an underlying bleeding disorder, and exposure to hemostatic challenges also influences the bleeding history. Among individuals referred for bleeding disorder evaluation, there is a high pretest probability for a bleeding disorder. The laboratory evaluation is important to identify the causes of underlying bleeding disorders, which can be congenital and acquired, and it requires consideration of the most appropriate diagnostic investigations. The formulation of a differential diagnosis and a bleeding symptom management plan is an important final step of a bleeding disorder assessment.