35. Differential diagnosis of conditions associated with an increased bleeding tendency.

Page created on February 23, 2022. Not updated since.


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

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