Approach to diagnose a case of bleeding disorder.

Anticipatory

What are the most important clinical and laboratory investigations that could help you to diagnose a case of bleeding disorder?

Objective

1- Identify the proper questions of history taking of case of bleeding disorder.

2- Interpret the result of investigation of case of bleeding disorder.

Instructional content

History taking :

Points to be asked during history taking :

1-Duration of the bleeding tendency

Inherited
Acquired

2-Family history of bleeding : if positive

Dominant
Recessive

2- location and type of bleeding

3- Is bleeding spontaneous or induced by trauma?

Physical examination:

Points to be addressed during physical examination

1- bleeding represented by petechiae or deep haematoma

2- Are hemarthroses present?

3- Are there telangiectasias?

Finding	Coagulation disorder	Platelet or vasculer disorder
Petechiae	rare	characteristic
deep haematoma	characteristic	rare
hemarthroses	characteristic	rare
Patient gender	Most inherited disorder in males	Most inherited disorder in females
Mucosal bleeding	minimal	typical

Laboratory investigations:

Results of laboratory tests for common bleeding disorder:

disorder	PT	aPTT	Platelet count	Bleeding time
Vonwillebrand's disease	Normal	Normal or increased	Normal	Normal or increased
Hemophilia A,B	Normal	Usually increased	Normal	Normal
Thrombocytopenia	Normal	Normal	Decreased	Usually increased
Vitamin K deficiency	Increased	Normal or increased	normal	Normal

True-False Question

True or false questions

Mucocutaneus bleeding is characteristic of platelet coagulation disorder.

True False

In a child with past history of post circumcision bleeding ,and present history of painful swollen joints(diagnosed as haemartharosis),platelet count is considered to be the most important screening test.

True False

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