Main Article Content
Abstract. Background: Bleeding is a common clinical presentation. Even patients with mild bleeding disorders are extensively investigated for ascertaining the cause. The present study was conducted in order to evaluate the extent of the possibility of diagnosis in mild bleeding disorders.
Material and Methods: This was a prospective study of patients referred for work up of mild bleeding for a period of 13 months. A complete blood count, peripheral smear examination, Prothrombin time, Partial Thromboplastin time and Thrombin Time, Platelet Aggregometry test, tests for von Willebrand’s disease and Platelet function 3 availability were measured.
Results: 164 patients presented with mild bleeding, in 114 of the patients a single site of bleeding was present. Epistaxis was the most common presentation (39%). Cutaneous bleeding (petechiae and purpura) was the next common site. History of a major bleeding tendency in the family was present only in 11 patients. The investigations showed that VWD (17/164), followed by clotting disorders (CD) mainly mild hemophilia (15/164) were the most common diagnosable cause. There were also 4 cases of hypofibrinogenemia. The disorders of platelets (Platelet function defects/PFD) were the least common (9/164). Rest 123 (75%) patients could not be diagnosed on the basis of these investigations and were labeled as Bleeding disorders – Unclassified (BDC).
Conclusion: n our study, 75% of the patients with mild bleeding remained undiagnosed even after extensive laboratory workup, thus raising a very pertinent question that is it necessary that all mild bleeders submit to a broad battery of investigations, as the diagnosis continues to be elusive despite extensive workup.
Downloads month by month
1. Quiroga T, Mezzano D. Is my patient a bleeder? A diagnostic framework for mild bleeding disorders. Hematol Educ Program Am Soc Hematol Am Soc Hematol Educ Program. 2012;2012:466–74.
2. Favaloro EJ. Investigating people with mucocutaneous bleeding suggestive of primary hemostatic defects: a low likelihood of a definitive diagnosis? Haematologica. 2007 Mar;92(3):292–6.
3. Hayward CPM. Diagnosis and management of Mild bleeding disorders. Hematology Am Soc Hematol Educ Program. 2005:423-8
4. Quiroga T, Goycoolea M, Panes O, Aranda E, Martínez C, Belmont S, et al. High prevalence of bleeders of unknown cause among patients with inherited mucocutaneous bleeding. A prospective study of 280 patients and 299 controls. Haematologica. 2007 Mar;92(3):357–65.
5. Khan MK, Khan SQ, Malik NA Spectrum of Von Willebrand's disease in Punjab: clinical features and types. J Ayub Med Coll Abbottabad. 2014 Oct-Dec;26(4):470-3.
6. Moerloose P,Levrat E,Fontana P,Boehlen. Diagnosis of mild bleeding disorders. Swiss med weekly 2009;139(23-24):327-332.
7. Watson HG, Greaves M. Can we predict bleeding? Semin Thromb Hemost. 2008 Feb;34(1):97–103.