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.



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