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Bleeding or bruising

  • Thrombocytopenia ddx (petechiae, low plt)

    • destruction: ITP, TTP (purpura), DIC, SLE, splenic sequestration
    • defective maturation: iron deficiency (microcytic anemia)
    • low production (marrow dysfunction): aplastic anemia, leukemia, MDS, myelofibrosis, Wiskott-Aldrich (eczema)
  • Platelet dysfunction ddx (bleeding time prolonged)

    • aspirin, antiplatelet drugs, uremia, myeloproliferative dz
  • Clotting factor deficiency ddx (PT > 14, PTT > 39)

    • vitamin K deficiency (malabsorption, prematurity, liver failure, cirrhosis, warfarin)
    • hemophilia
    • von Willebrand's disease
    • circulating antibodies, inhibitors
    • heparin
    • DIC
  • Drugs ddx

    • aspirin, antiplatelets, heparin, warfarin
  • Other ddx

    • scurvy, trauma, senile purpura, Cushing's, HSP, meningitis
  • Labs

    • CBC
    • coag panel
    • clotting factor titer
    • autoantibodies panel
  • HPI

    • onset
    • triggering event
    • location of bruises
    • quantity, severity
  • ROS

    • fever, fatigue, weight loss, pika
    • rash, petechiae, purpura
    • bleeding, bruising, nosebleed, menorrhagia, blood in stool, hematuria
    • cardio: chest pain
    • pulm: cough, dyspnea
    • GI: nausea, vomiting, diarrhea
    • MSK: arthralgia
  • PMH

    • bleeding disorders
    • liver disease
    • cancer
  • FH

    • bleeding disorder
  • SH

    • EtOH, tobacco
  • Meds

    • warfarin, drug-drug interactions, OTC supplements
    • anticoagulation
  • Allergies

  • Px

    • vitals
    • gen impression
    • skin: rash, petechiae, purpura, bruising. Location, size.
    • ENT: mucosal pallor
    • cardio
    • pulm
    • abd: splenomegaly
    • lymphadenopathy
    • ext: hemarthrosis

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.