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Mild bleeding disorders. A clinical and laboratory study
J D Parkin1, I L Smith, A I O'Neill
1Haematology Department, Repatriation General Hospital, Heidelberg West, VIC.
Objective:
To investigate in-vitro haemostasis in subjects with symptoms suggesting a mild bleeding disorder.
Design:
A prospective study in which an extensive range of in-vitro tests were applied unselectively.
Setting:
Patients were referred from community-based practices and hospital outpatient services.
Patients:
Ninety-three consecutive patients were examined. Hospital patients with severe illness were excluded.
Clinical Features:
Patients presented with easy bruising (68%), epistaxis (12%), excessive operative bleeding (7%), menorrhagia (4%), haematuria (3%), dental bleeding (1%) and bleeding from other sites (5%). In no instance was the bleeding life threatening.
Outcome Measures:
Results of laboratory tests for patients presenting with the symptoms of a mild bleeding disorder were compared with the results for a healthy reference group.
Results:
Abnormal results of in-vitro tests were found in 53% of the subjects. Thirteen per cent had a prolonged bleeding time, of whom the majority had abnormal results of other in-vitro tests. Von Willebrand's disease was diagnosed in 7% of patients, although only half of these had a prolonged bleeding time.
Conclusions:
Abnormal results of in-vitro tests were prevalent among subjects with symptoms of mild bleeding disorder. Easy bruising was as powerful a clue as any other bleeding manifestation to the presence of an abnormal in-vitro test result.