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|