Evaluation of the Bleeding Patient

Few evaluations in hematology provoke as much diagnostic uncertainty as that of the patient with a suspected bleeding diathesis. The evaluation, including history, physical examination, and laboratory testing, is aimed at determining the likelihood that the patient has an underlying hemorrhagic disorder, as well as the treatment of future bleeding episodes. The evaluation is fraught with diagnostic uncertainty, because many historical features are shared by individuals without bleeding diatheses, laboratory studies may have a significant false-positive rate, and external pressures (such as insurance coverage) may limit the diagnostic testing available to the patient and physician. This chapter will attempt to present a systematic approach to the individual with a suspected bleeding disorder.