Monday, April 24, 2017

An Approach To Patient With Bleeding

When ever a patient presents with the main complaint of bleeding there are three set of questions that need to be answered ;

1. Is There an Emergency?
A condition that may need and immediate resuscitation or help by a senior. The patient may seem to faint or go into shock. check the blood pressure for hypotension. Consider any signs of CNS bleeding like meningism as it is also an emergency. Also consider an underlying condition in which an apparently minor bleed may evolve into a catastrophic event like bleeding in pregnancy or the puerperium.

2. Why Is the Patient Bleeding?
It is important for a physician taking care of a patient with bleeding to think that is the bleeding with which the patient has presented is normal given the circumstances for example surgery, trauma, postpartum etc or that there is some other reason like bleeding disorder, drugs, liver disease or sepsis that is leading to the problem.

3. What is the mechanism of bleeding If it is a case of bleeding disorder?
To help find the answer some diagnostic tests need to be done like full blood count, coagulation studies, D-dimers, bleeding time etc.

  • It depends upon the degree of bleeding as well as underlying cause of bleeding.
  • If the patient is going in shock it is very important to start resuscitation and bring him out of hypovolemia and hypotension.
  • Take a detailed history to determine the cause of bleeding and rule out any bleeding disorders.
  • It is important to take a family history of any bleeding diseases.
  • Ask the patient about the medications he is using and any recent change or new addition in the prescribed drugs.
  • Get the laboratory workup done for coagulation disorder. the blood grouping and complete blood count.
  • Arrange the blood for transfusion in case if needed.
  • Once the specific cause is identified treat accordingly


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