Bruising / Bleeding

Easy Bruising
  1. r/o Physical abuse
  2. Reassure if bruising isolated to extremities & no Red Flags
Red Flags to Suggest Bleeding Disorder (w/u as for Easy Bleeding below)
  • ≥5 bruises that are >1 cm. diameter
  • Any unexplained palm-sized bruise
  • Frequent epistaxis or gingival bleeds
  • Menorrhagia or Metrorrhagia
  • Bleeding complications from prior dental work or surgery
  • History of atraumatic hemarthrosis
  • Alcoholic, Malnourished
  • Family History of bleeding disorder
Easy Bleeding
  • Obtain Platelet Count (with CBC), PT, PTT
  • If Platelets low but >30,000, NOT cause of bleed (but W/U anyway)
  • If Platelets <30,000/mcrL:
    • Obtain HIV antibody
    • r/o Drug-Induced Thrombocytopenia (history)
    • If low WBC / RBC → to Heme
    • Isolated low Platelets → Dx ITP → to Heme for Tx if <30,000
  • If PT and/or PTT elevated:
    • Obtain LFTs, work-up if abnormal
    • Send to Heme
  • Platelets, PT, PTT all normal → r/o von Willebrand’s
    •  Von Willebrand factor Antigen
    • Plasma VWF activity (aka Ristocetin Cofactor activity)
    • Factor VIII activity
  • No Diagnosis, & concerned re Easy Bleeding → to Heme
Petichiae & Purpura  —  Work up Vasculitis
  • Platelets, PT, PTT all likely normal
  • Simple Initial Tests: CBC, ESR, ANA, Hep B & C serologies
  • Send to Rheumatology
  • May benefit from biopsy

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