Vol. 21 No. 1 (2023)
An Approach To:

Approach to: Bleeding

PDF HTML
  • Ryan Antel
Ryan Antel
Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
A man shows a bleeding hand
DOI: https://doi.org/10.26443/mjm.v21i1.953

Published 2022-10-12

Keywords

  • Bleeding,
  • Coagulation,
  • Hemostasis

How to Cite

1.
Antel R. Approach to: Bleeding. McGill J Med [Internet]. 2022 Oct. 12 [cited 2025 Oct. 20];21(1). Available from: https://mjm.mcgill.ca/article/view/953

Copyright (c) 2022 Ryan Antel

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Crossref
Scopus
Google Scholar
Europe PMC

Abstract

This article presents a basic approach to the bleeding patient and is intended for medical students in their pre-clinical and clerkship years. Easy bruising and abnormal bleeding are relatively common symptoms, and may present as excessive bleeding post-injury, epistaxis, menorrhagia, prolonged bleeding after surgery or spontaneous bleeding. Identification and appropriate medical management of abnormal bleeding and bruising can decrease associated morbidity and mortality.

PDF HTML

Downloads

Download data is not yet available.

References

  1. Kurth AA, Ludwig G, Scharrer I. [Prevalence, pathophysiology, diagnosis and treatment of von Willebrand syndrome in orthopedic trauma patients]. Orthopade. 1999;28(4):366-74 doi:10.1007/PL00003619 Available from: https://www.ncbi.nlm.nih.gov/pubmed/10335531
  2. https://link.springer.com/content/pdf/10.1007/PL00003619.pdf.
  3. Ng C, Motto DG, Di Paola J. Diagnostic approach to von Willebrand disease. Blood. 2015;125(13):2029-37 doi:10.1182/blood-2014-08-528398 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375103/.
  4. Swami A, Kaur V. von Willebrand Disease: A Concise Review and Update for the Practicing Physician. Clin Appl Thromb Hemost. 2017;23(8):900-10 doi:10.1177/1076029616675969 Available from: https://www.ncbi.nlm.nih.gov/pubmed/27920237.
  5. D'Andrea G, Chetta M, Margaglione M. Inherited platelet disorders: thrombocytopenias and thrombocytopathies. Blood Transfus. 2009;7(4):278-92 doi:10.2450/2009.0078-08 Available from: https://www.ncbi.nlm.nih.gov/pubmed/20011639
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782805/pdf/blt-07-278.pdf.
  7. Gopinath R, Sreekanth Y, Yadav M. Approach to bleeding patient. Indian J Anaesth. 2014;58(5):596-602 doi:10.4103/0019-5049.144664 Available from: https://www.ncbi.nlm.nih.gov/pubmed/25535422
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260306/pdf/IJA-58-596.pdf.
  9. Levi M, Ten Cate H. Disseminated intravascular coagulation. N Engl J Med. 1999;341(8):586-92 doi:10.1056/NEJM199908193410807 Available from: https://www.ncbi.nlm.nih.gov/pubmed/10451465.
  10. Perez Botero J, Di Paola J. Diagnostic approach to the patient with a suspected inherited platelet disorder: Who and how to test. J Thromb Haemost. 2021;19(9):2127-36 doi:10.1111/jth.15484.
  11. Neutze D, Roque J. Clinical Evaluation of Bleeding and Bruising in Primary Care. Am Fam Physician. 2016;93(4):279-86 Available from: https://www.ncbi.nlm.nih.gov/pubmed/26926815
  12. https://www.aafp.org/afp/2016/0215/afp20160215p279.pdf.
  13. Kruse-Jarres R, Singleton TC, Leissinger CA. Identification and basic management of bleeding disorders in adults. J Am Board Fam Med. 2014;27(4):549-64 doi:10.3122/jabfm.2014.04.130227 Available from: https://www.ncbi.nlm.nih.gov/pubmed/25002009
  14. https://www.jabfm.org/content/jabfp/27/4/549.full.pdf.
  15. Kamal AH, Tefferi A, Pruthi RK. How to interpret and pursue an abnormal prothrombin time, activated partial thromboplastin time, and bleeding time in adults. Mayo Clin Proc. 2007;82(7):864-73 doi:10.4065/82.7.864 Available from: https://www.ncbi.nlm.nih.gov/pubmed/17605969
  16. https://www.mayoclinicproceedings.org/article/S0025-6196(11)61313-X/pdf.
  17. Benson G, Auerswald G, Dolan G, Duffy A, Hermans C, Ljung R, et al. Diagnosis and care of patients with mild haemophilia: practical recommendations for clinical management. Blood Transfus. 2018;16(6):535-44 doi:10.2450/2017.0150-17.
  18. Russeau AP, Vall H, Manna B. Bleeding Time. StatPearls. Treasure Island (FL)2022.
  19. Al-Huniti A, Kahr WH. Inherited Platelet Disorders: Diagnosis and Management. Transfus Med Rev. 2020;34(4):277-85 doi:10.1016/j.tmrv.2020.09.006 Available from: https://www.ncbi.nlm.nih.gov/pubmed/33082057
  20. https://www.sciencedirect.com/science/article/abs/pii/S0887796320300523?via%3Dihub.
  21. Iba T, Levy JH. Sepsis-induced Coagulopathy and Disseminated Intravascular Coagulation. Anesthesiology. 2020;132(5):1238-45 doi:10.1097/aln.0000000000003122 Available from: https://pubs.asahq.org/anesthesiology/article/132/5/1238/109000/Sepsis-induced-Coagulopathy-and-Disseminated.
  22. Casari C, Bergmeier W. Acquired platelet disorders. Thromb Res. 2016;141 Suppl 2:S73-5 doi:10.1016/S0049-3848(16)30371-1 Available from: https://www.ncbi.nlm.nih.gov/pubmed/27207431
  23. https://www.thrombosisresearch.com/article/S0049-3848(16)30371-1/fulltext.
  24. Greenberg EM, Kaled ES. Thrombocytopenia. Crit Care Nurs Clin North Am. 2013;25(4):427-34, v doi:10.1016/j.ccell.2013.08.003.
  25. Abuzeid AM, O'Keeffe T. Review of massive transfusion protocols in the injured, bleeding patient. Curr Opin Crit Care. 2019;25(6):661-7 doi:10.1097/mcc.0000000000000668 Available from: https://journals.lww.com/co-criticalcare/Abstract/2019/12000/Review_of_massive_transfusion_protocols_in_the.18.aspx.