Mild bleeders: Diagnosis is elusive in large number of patients

Abstract

BackgroundBleeding is a common clinical presentation. Even patients with mild bleeding disorders are extensively investigated for ascertaining the cause. The present study was conducted in order to evaluate the extent of the possibility of diagnosis in mild bleeding disorders.Material and MethodsThis was a prospective study of patients referred for work up of mild bleeding for a period of 13 months. A complete blood count, peripheral smear examination, Prothrombin time, Partial Thromboplastin time and Thrombin Time, Platelet Aggregometry test, tests for von Willebrand’s disease and Platelet Factor 3 availability were measured.Results164 patients presented with mild bleeding, in 114 of the patients a single site of bleeding was present. Epistaxis was the most common presentation (39%). Cutaneous bleeding (petechiae and purpura) was the next common site. History of a major bleeding tendency in the family was present only in 11 patients. The investigations showed that VWD (17/164), followed by clotting disorders (CD) mainly mild hemophilia (15/164) were the most common diagnosable cause. There were also 4 cases of hypofibrinogenemia. The disorders of platelets (Platelet function defects/PFD) were the least common (9/164). Rest 123 (75%) patients could not be diagnosed on the basis of these investigations and were labeled as Bleeding disorders – Unclassified (BDC).Conclusionn our study, 75% of the patients with mild bleeding remained undiagnosed even after extensive laboratory workup, thus raising a very pertinent question that is it necessary that all mild bleeders submit to a broad battery of investigations, as the diagnosis continues to be elusive despite extensive workup.

Hematidrosis (bloody sweat): a review of the recent literature (1996–2016)

“…One Indian patient was diagnosed with PF3 dysfunction (12) with prothrombin time, activated partial thromboplastin, thrombin time, and bleeding time within normal ranges. As emphasized by a recent Indian study, 75% of patients with mild bleeding remain undiagnosed even after extensive laboratory workup (32). To date, hematidrosis has not been connected to any bleeding disorder.…”

Approach to the Coagulopathic Patient in the Intensive Care Unit

“…Only 25% of the patients were confirmed to have a bleeding disorder based on the investigation, and the rest labeled as unclassified bleeding disorder. 7…”