Helpful Clinical Features in Evaluating Bleeding Disorders Age of onset • Neonate - in 20% of haemophilias, bleeding occurs in the neonatal period, usually with intracranial haemorrhage or bleeding after circumcision • Toddler — haemophilias may present when starting to walk • Adolescent — von Willebrand disease may present with menorrhagia Family history • Family tree - detailed family tree required • Gender of affected relatives (if all boys, suggests haemophilia) Bleeding history • Previous surgical procedures and dental extractions - if uncomplicated, suggests bleeding tendency is acquired rather then inherited • Presence of systemic disorders • Drug history, e.g. anticoagulants • Unusual pattern or inconsistent history - consider non-accidental injury Pattern of bleeding • Mucous membrane bleeding and skin haemorrhage — characteristic of platelet disorders or von Willebrand disease • Bleeding into muscles or into joints - characteristic of haemophilia • Scarring and delayed haemorrhage — suggestive of disorders of connective tissue, e.g. Marfan syndrome, osteogenesis imperfecta or factor XIII deficiency. #Bleeding #Disorders #History #peds #pediatrics #diagnosis #hematology #primarycare
