Assessment and treatment of a patient with bleeding diathesis

Extract

• In primary care, the principal aim should be to identify patients whose bleeding diathesis could be caused by leukaemia, meningococcal septicaemia or other acute systemic disease, severe haemorrhagic disease, medication-induced complication or an assault.
• This article describes the assessment of a patient with a bleeding diathesis. The principles differ from those of the assessment of a patient with an acute haemorrhage.
• Laboratory investigations are indicated in patients who have a bleeding diathesis either themselves or in their close relatives, or if there are laboratory findings suggesting a hereditary or acquired bleeding diathesis.
• In addition to clinical examination, the patient’s age, sex, underlying diseases, medication, and occurrence of bleedings in the patient and close relatives will provide essential information that is required before additional investigations are ordered.
• A haemostatic disorder leading to a bleeding diathesis may be acquired or hereditary. In both cases, such a disorder may either be mediated via platelets or coagulation factors. Bleeding diathesis may also be caused by abnormal fibrinolysis or by structural abnormalities in the vessel walls or in connective tissue.

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Bleeding Time, Bleeding diathesis, Blood Coagulation Factors, Blood Platelet Disorders, D68, D68.0, D68.9, D69*, Haematology, Haemorrhage, Hemorrhage, Hemorrhagic Disorders, Hemorrhagic Disorders, I78.0, Internal medicine, International Normalized Ratio, Kidney Diseases, Liver Diseases, Partial Thromboplastin Time, Q79.6, R58, Thrombocytopenia, Uremia, Vitamin K, activated partial thromboplastin time, frozen plasma