A careful and detailed clinical history is the most valuable part of the haemostatic assessment. If the history of bleeding is convincing, a minor bleeding disorder may well exist, even if the laboratory tests fall within the normal reference interval. The clinical history therefore primarily determines which patients need a laboratory work-up. Conversely, the laboratory findings cannot be adequately interpreted without considering the bleeding history.
Ask specifically about:
| EPISTAXIS | Especially if bilateral, recurrent, or requiring (repeated) cautery. |
| BRUISING | Specify size; whether it is spontaneous; and the degree of associated trauma. Trunk and upper arm bruising is potentially more important than lower limb bruising. Deep bruising has a central, hard (often pale) area |
| LACERATIONS | Particularly recurrent and prolonged bleeding and poor wound healing. |
| SURGERY | Wisdom teeth extraction, tonsillectomy, other major surgery and the blood transfusion requirement. Was there a delayed postoperative hospital stay. |
| DENTAL EXTRACTION | Size of tooth, presence of infection, impacted or straightforward, degree of bleeding. |
| MENORRHAGIA | Commonly presenting at menarche (documented anaemia?) Has a hysterectomy been performed for this indication? |
| GUM BLEEDING | When brushing teeth. |
| FAMILY HISTORY | onset of symptoms/family history may indicate inherited disorder. |
| DRUGS | Specifically ask about medication use for headache, arthralgias, and insomnia. Proprietary drug ingestion? Specific agents, particularly aspirin, NSAIDS. |
See: