Professor Medical University Vienna Vienna, Austria
Bleeding tendency is among the most common concerns seen by hematologists. Distinguishing between clinically insignificant bleeding and a bleeding phenotype that necessitates hemostatic evaluation and medical intervention can be challenging. A comprehensive review of personal and family history, an objective assessment of bleeding severity using a bleeding assessment tool, and a focused physical examination are essential for accurately identifying patients with mild to moderate bleeding disorders (MBDs).
All patients referred for a bleeding tendency should undergo a basic laboratory work-up. If a hemostatic abnormality is detected, such as von Willebrand disease, a platelet function disorder, or a coagulation factor deficiency, further specialized testing is required to better characterize the disorder. Conversely, if test results are normal, the patient is classified as having a bleeding disorder of unknown cause (BDUC).
For patients with BDUC, additional evaluation may involve non-routine tests to identify rare bleeding disorders not detected by standard hemostasis tests, such as thrombomodulin-associated coagulopathy, tissue factor pathway inhibitor-related bleeding disorder, hyperfibrinolytic-bleeding disorders, or impaired tissue factor production. This talk outlines the stepwise diagnostic approach to MBDs and BDUC.
Learning Objectives:
Investigating mild to moderate bleeding disorders (MBDs) can be challenging due to the variability in clinical presentation and the complexity of hemostatic pathways. This presentation will provide a structured, stepwise approach to evaluating patients with suspected bleeding disorders.
We will begin by discussing the importance of a detailed personal and family history, along with the use of bleeding assessment tools to quantify bleeding severity.
Next, we will explore the essential laboratory work-up. For cases where routine tests yield normal results but bleeding symptoms persist, we will review the concept of bleeding disorder of unknown cause (BDUC) and the role of advanced diagnostic tools in identifying rare bleeding disorders, such as hyperfibrinolytic states and thrombomodulin-associated coagulopathies.
By the end of this session, attendees will gain a comprehensive understanding of how to systematically approach mild to moderate bleeding disorders, ensuring accurate diagnosis.
