Bleeding disorders: A general approach

Patients with bleeding disorders may present in a variety of ways. Using the history and basic screening tests, one can narrow the differential considerably. Bleeding with coagulation disorders is excessive for the situation, prolonged, and recurrent. For example, a patient with hemophilia will bleed for several hours from a minor wound before a clot forms, and then the bleeding may recur for days. Patients with mild bleeding disorders will manifest bleeding with dental extractions and surgeries. However, some patients with von Willebrand disease (due to the variability of the disease) may have had previous hemostatic challenges and not suffered significant bleeding.