blood clotting process
blood disorders
Bruising and Bleeding
Doctors first try to establish whether the person's symptoms actually represent easy or excessive bleeding. If so, they look for possible causes. The following information can help people know when to see a doctor and help them know what to expect during the evaluation. In people with easy bruising or bleeding, certain symptoms and characteristics are cause for concern. They include Symptoms of serious blood loss, such as sweating, weakness, faintness or dizziness, nausea, or extreme thirst Pregnancy or recent delivery Signs of infection, such as fever, chills, diarrhea, or feeling ill all over Headache, confusion, or other sudden symptoms related to the brain or nervous system People with warning signs should see a doctor right away, as should those who are still bleeding and those who have lost more than a small amount of blood. People without warning signs who notice that they bleed or bruise easily should call their doctor. The doctor determines how quickly to evaluate people based on their symptoms and other factors. Typically, people who do not feel well or have risk factors for bleeding, such as liver disease or use of certain medications, or who have a family history of a bleeding disorder should be seen within a day or two. People who feel well but had a few nosebleeds that stopped on their own or who have bruises or spots on their skin can be seen when practical. A delay of a week or so is unlikely to be harmful. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination sometimes suggests a cause of the bleeding or bruising, but typically tests need to be done. Doctors ask about types of bleeding, including frequent nosebleeds, gum bleeding while tooth brushing, coughing up blood (hemoptysis), blood in stool or urine, or dark tarry stool (melena). They also ask about other symptoms, including abdominal pain and diarrhea (suggesting a digestive disorder), joint pain (suggesting a connective tissue disorder), and lack of menstrual periods and morning sickness (suggesting pregnancy). They ask about whether the person is taking medications (such asaspirin,indomethacin,heparin, orwarfarin) that are known to increase the risk of bleeding. Easy bleeding in a person takingwarfarin, especially if the dose has recently increased, is likely due to the medication. Doctors also ask if the person has a condition that is likely to cause a problem with blood clotting, such as Severe infection, cancer, Overview of Liver Disease (such as cirrhosis or hepatitis), Prior excessive or unusual bleeding or the need for Overview of Blood Transfusion None Family history of excessive bleeding People are asked about use of alcohol or intravenous (IV) drugs. Heavy alcohol use is a risk factor for liver disease, and IV drug use is a risk factor for HIV infection. People with a family history of excessive bleeding are likely to have an inherited bleeding disorder such as Hereditary Hemorrhagic Telangiectasia (HHT) , During the physical examination, doctors check vital signs (temperature, blood pressure, and heart rate). These signs can give an early indication of serious disorders, especially low blood volume or an infection. A high heart rate together with low blood pressure suggests low blood volume due to bleeding. Fever suggests an infection. Doctors examine the skin and mucous membranes (nose, mouth, and vagina) looking for signs of bleeding. A digital rectal examination is done to look for bleeding from the digestive tract. Doctors also look for signs, such as tenderness during movement and local swelling, that may indicate bleeding in deeper tissues. A person with bleeding inside the head may have confusion, a stiff neck, or neurologic abnormalities (such as headache, vision problems, or weakness). The sites of bleeding may offer a clue to the cause. Bleeding from superficial sites, including skin and mucous membranes, suggests a problem with platelets or blood vessels. On the other hand, bleeding into deep tissues suggests a problem with clotting. Additional findings may help doctors narrow the cause. Accumulation of fluid in the abdomen (ascites), an enlarged spleen (splenomegaly), and yellow color of the skin and/or eyes (jaundice) suggest bleeding caused by liver disease. A woman who is pregnant or has recently delivered or a person who is in Shock or has a fever, chills, and other signs of serious infection is at risk of Most people with excessive bleeding require blood tests. The initial tests are Complete blood count (including platelet count), which evaluates all the cellular components of a blood sample Blood smear (examination of a sample of blood under a microscope to see whether blood cells are damaged, abnormal, or immature) Prothrombin time (PT) and partial thromboplastin time (PTT), which Clotting tests None These tests are considered screening tests. They are done to determine whether the clotting system is normal. If one of these tests reveals an abnormality, additional tests are usually needed to identify the cause. Other blood tests may be needed to confirm bleeding caused by HIV infection or Overview of Hepatitis . A are often done to detect internal bleeding in people with bleeding disorders. For example, Computed Tomography (CT) (CT) of the head should be done in people with severe headaches, head injuries, or impairment of consciousness. Abdominal CT is done in people with abdominal pain. 