Clinical Types of Bleeding

The laboratory plays a central role in evaluation of a bleeding patient. Every patients with bleeding needs to be screened with a prothrombin time, activated partial thromboplastin time, thrombin time, platelet count and assessment of factor XIII. These tests help to classify the patients into one of the following groups of defects – thrombocytopenia, defects of the intrinsic coagulation system or defects of the extrinsic coagulation system. The  patterns of bleeding in disease of platelets and coagulation are sufficiently distinct to allow a clinical distinction between the two groups of bleeding disorders.

The table below gives the differences between bleeding due to a platelet/vascular disease and a coagulopathy.

Clinical Feature	Platelet/Vascular Defects	Coagulopathy
Gender Predilection	Slight female preponderance as immunotrhrombocytopenia is more common in women	Domanantly male because the commonest coagulation factor deficiencies are X linked inherited disorders
Family/Personal History of bleeding	Uncommon	Common
Mucosal Bleeding	Common	Less common
Muscle and Joint Bleeding	Uncommon	Typical. Dissecting haematomas seen.
Skin Bleeding	Typically petechiae. Ecchymosis when present tend to few in number	Typically bruising. Ecchymosis when present tend to be large and multiple
Delayed Bleeding	Unusual	May be present
Bleeding from superficial wounds	Persistant	Minimal