S2D: The Symptom to Diagnosis Podcast Bleeding Disorders
Apr 14, 2021
Explore the intriguing world of bleeding disorders, starting with a case of large unexplained bruises. Distinguish between petechiae, purpura, and ecchymoses while diving into diagnostic lab tests. Uncover the five-point framework for assessing bleeding, including platelet vs coagulation disorders. Learn about ITP diagnosis and treatment, misconceptions about HIT, and the urgency of conditions like TTP. Scott and Adam also discuss the importance of addressing abnormal lab results and the misconceptions surrounding elderly bruising.
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Unexpected Large Bruises Without Trauma
- Scott Stern described a family member who presented with large, non-tender ecchymoses on the foot and thigh without recalled trauma.
- The patient had no mucosal bleeding and otherwise normal exam, prompting outpatient-style evaluation.
Start With CBC and Basic Coagulation Tests
- Start the workup of unexplained bleeding with a CBC with differential, platelet count, PT/INR and PTT.
- Use those simple tests to separate platelet disorders from coagulation disorders before ordering more complex studies.
Classic Bleeding Patterns Are Unreliable
- The classic teaching that platelet disorders cause mucosal bleeding and coagulopathies cause deep bleeding is unreliable.
- Scott Stern recommends not trusting that rule and instead using labs to guide diagnosis.
