Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Bleeding (Excessive)
Introduction
Overview
Overview
Bleeding occurring spontaneously without injury, or bleeding that does not stop (with direct pressure) is abnormal.
Classification
Classification
Abnormal bleeding can be classified into the following groups:
- Coagulation factor disorders
- Platelet disorders
- Vascular disorders
Causes
Causes
In alphabetical order. [1] [2]
- Arteriovenous malformation
- Bernard-Soulier Syndrome
- Capillary wall abnormalities
- Disseminated intravascular coagulation (DIC)
- Drugs:
- Ehlers-Danlos Syndrome
- Glanzmann’s Syndrome
- Hemolytic Uremic Syndrome and Thrombotic Thrombocytopenic Purpura (HUS-TTP)
- Hemophilia
- Heparin-Induced Thrombocytopenia
- Hereditary hemorrhagic telangiectasia
- HIV
- Immune Thrombocytopenic Purpura (ITP)
- Isolated factor deficiency
- Leukemia
- Liver disease
- Myelodysplasia
- Pancytopenia
- Schönlein-Henoch Purpura (HSP)
- Senile purpura
- Severe vitamin K deficiency
- Uremia
- Von Willebrand’s Disease
Diagnosis
Diagnosis
History and Symptoms
- Complete history
- Family history
- Minor trauma bleeding
- Tooth extractions
- Postsurgical bleeding
- Medications
- Menorrhagia
Physical Examination
- Complete physical examination including rectal exam and joint exam (hemarthrosis)
Laboratory Findings
- Complete blood count (CBC) with peripheral smear
- Partial thromboplastin time (PTT)
- Thrombin time
- Bleeding time
- Urinalysis
- Platelet count
- Prothrombin time / international normalized ratio (PT / INR)
Other Diagnostic Studies
- Stool guaiac testing
- Bone marrow aspiration
- Specific factor assays
- Platelet adhesion and aggregation testing
- Urea clot lysis test
- Fibrinogen assay
- Mixing studies
Treatment
Treatment
- Treatment of underlying disease processes
- Remove offending drugs
- Transfusion and hemostasis
- Rapid IV hydration
- Supplemental oxygen
- Administration of fresh frozen plasma (DIC and liver disease)
- Administration of cyroprecipitate (uremia, DIC, von Willebrand’s disease and hemophilia)
- Intravenous immunoglobulin (IVIG) for patients with ITP in emergency situations
- Factor VIII concentrate (von Willebrand’s disease and hemophilia)
Acute Pharmacotherapies
- Desmopressin (DDAVP) for uremia, von Willebrand’s and hemophilia
- Parenteral vitamin K (vitamin K deficiency)
- Corticosteroids (ITP, HSP)
- Tranexamic acid (liver disease)
Contraindicated medications
Active pathological bleeding is considered an absolute contraindication to the use of the following medications:
Surgery and Device Based Therapy
References
References
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]