Bleeding disorders
Bleeding disorders - general

Topic Completed: 1 June 2012

Revised: 4 January 2018, last major update June 2012

Copyright: (c) 2002-2016,, Inc.

PubMed Search: Bleeding disorders [title]

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Cite this page: Parsons J. Bleeding disorders - general. website. Accessed August 15th, 2020.
Definition / general
  • Bleeding disorders are often classified as defects of primary hemostasis (platelets, vessels, etc.) or of secondary hemostasis (coagulation cascade and its regulation)
Clinical features
  • Clinical history is important:
    • Single site (suggests structural lesion) vs. multiple sites (coagulopathy)
    • For coagulopathies: hereditary (family history of bleeding or bleeding since childhood) vs. acquired (no previous bleeding history)
    • Time from “hemostasis challenge” to bleeding symptoms:
      • Immediate suggests platelet / primary hemostasis disorder (inability to form normal platelet plug) versus late suggests coagulopathy / secondary hemostasis (breakthrough bleeding occurs after platelet plug due to impaired fibrin formation)
      • Even further delay suggests a Factor XIII deficiency (fibrin clot forms to stop bleeding but is unstable and breaks down due to lack for crosslink stabilization)
    • Physical exam: petechiae (primary hemoastasis / platelet disorders) vs. hematoma or hemarthrosis (secondary hemostasis / coagulation defects) vs. mucous membrane bleeding or bruising (nonspecific, often primary hemostasis)
Clinical images

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