Table of Contents
Page created on February 23, 2022. Not updated since.
Introduction
A bleeding diathesis or bleeding disorder is a disorder which is characterised by increased bleeding tendency. This is most commonly due to defects in coagulation factors or platelet number or function.
Bleeding diatheses can be inherited or acquired. If there is history of excessive bleeding or bruising the whole life, an inherited disorder is most likely.
Differential diagnosis
Disorders of platelets and their interaction with blood vessels (disorders of primary haemostasis) and disorders of clotting factors (disorders of secondary haemostasis) generally cause different clinical features:
| Bleeding characteristics | Platelet disorder | Clotting factor disorder |
| Major sites of bleeding | Skin, mucous membranes (mouth, nose, GI tract, urinary tract, menorrhagia) | Joints, muscles, soft tissue |
| Petechiae | Common | Uncommon |
| Ecchymoses | Small and superficial | Large |
| Excessive bleeding after minor cuts | Yes | Uncommon |
| Excessive bleeding with surgery or invasive procedures | Immediate | During or after the procedure, but not immediate |
Differential diagnosis of platelet disorders
| Etiology | Typical features |
| Immune thrombocytopaenia | Sudden onset, preceded by viral infection |
| Acute leukaemia | Anaemia, lethargy, infections, organomegaly |
| DIC | Bleeding from venepuncture sites, widespread bleeding and thrombosis |
| Neonatal alloimmune thrombocytopaenia | Neonate with no other clinical features |
| Liver failure | Jaundice, hepatomegaly |
| Haemolytic uraemic syndrome (HUS) | Follows a GI or URTI infection. Acute renal failure, anaemia, schistocytes on blood smear |
Differential diagnosis of clotting factor disorder
| Etiology | Typical features |
| Haemophilia | Only males, increased tendency to bleed after trauma or surgery |
| Von Willebrand disease | Bruising, excessive bleeding after surgery, epistaxis, and menorrhagia |