Therapeutic Principles of Bleeding Disorders

The approach to a patient with excessive bleeding should start with a history and physical exam. The onset of bleeding at birth or childhood may suggest a congenital bleeding disorder, while onset later in life suggests an acquired disorder. Bleeding may be spontaneous or after a procedure or surgery. The pattern of bleeding, whether it is mucocutaneous or soft-tissue bleeding, may also aid in coming to a diagnosis. Patients with disorders of primary hemostasis (platelets and von Willebrand disease [vWD]) often experience mucocutaneous bleeding, while those with disorders of secondary hemostasis (coagulation pathway disorders) will experience deep-tissue or central nervous system bleeding. It is critical to discuss medications, surgical history including dental procedures, past medical history, and family history to further understand the possible etiology of bleeding. It is of utmost importance to discern normal bleeding from abnormal bleeding. Treatment of recurrent bleeding with normal coagulation-factor assays depends on the cause and severity of bleeding. In this chapter, we will discuss the general treatment of bleeding including bleeding caused by trauma and disorders or hemostasis.