Patients who experience recurrent bleeding episodes are a select group of individuals that need to be evaluated for the source of their bleeding disorder. Bleeding may occur due to an inherited clotting factor defect or an acquired deficiency secondary to some other cause. Factors that should be considered in evaluating a bleeding disorder are the patient history, physical examination, laboratory testing, and family bleeding history. Often, the abnormal bleeding that they experience is not perceived as abnormal because that is all that they have ever known. Therefore, the questions that are asked relative to the types of and frequency of their bleeding need to be extremely specific and nonthreat-ening. Bleeding comes under two main categories: open bleeds and closed bleeds.
Open bleeds are those types of bleeding such as tongue bleeding, tonsil bleeding, gum bleeding, epistaxis, menorrhagia, umbilical cord bleeding, and cir-cumcisional bleeding. Closed bleeds are soft tissue bleeds, genitourinary bleeding, gastrointestinal bleeding, and bleeding into the muscle, joints, skin, bone, or skull. Not every patient experiences all types of bleeding; some patients with clotting factor deficiencies never experience a bleeding episode. Yet, it is prudent to gather as much information as can be obtained to assess an individual with a history of bleeding.
Plasma clotting factors are inactive enzymes that circulate in plasma awaiting activation when injury occurs. They represent a significant ingredient to the proper clotting mechanism. Clotting factors that are poorly synthesized, inactivated by inhibitors, consumed by a rogue clotting process or functionally impaired will lead to faulty hemostasis.
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