Skip to main navigation menu Skip to main content Skip to site footer

An Approach To:

Vol. 21 No. 1 (2023)

Approach to: Bleeding

January 7, 2022


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.


  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:
  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:
  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:
  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:
  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:
  9. Levi M, Ten Cate H. Disseminated intravascular coagulation. N Engl J Med. 1999;341(8):586-92 doi:10.1056/NEJM199908193410807 Available from:
  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:
  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:
  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:
  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:
  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:
  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:
  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:


Download data is not yet available.