Table 1. Historical Factors to Explore in Adults Presenting With Abnormal Bleeding
Personal history of bleeding and description of bleeding events
    Severity (including need for any medical or surgical treatments)
    Anatomic location
    Spontaneous or provoked
Complete medication history, including OTC medications (many of which contain aspirin or NSAIDs)
History of excessive or prolonged bleeding after trauma or surgery (including dental procedures)
History of menorrhagia* (including age of onset) or excessive postpartum bleeding in women
Family history of any of the above bleeding sequelae or of a known heritable bleeding disorder (or consanguinity in cases of autosomal recessive disorders8)
Personal or family history of blood product transfusion and the reasons for transfusion, if known
Personal history or symptoms of any conditions associated with coagulopathy (eg, liver disease) or with specific bleeding disorders (eg, malignancy or autoimmune disease in acquired hemophilia)
History of recurrent miscarriage in women
Personal or family history of thrombotic events
  • * Menorrhagia is defined by heavy menstrual bleeding of more than 7 days' duration7; >80 mL of blood loss per menstrual cycle7; needing to change sanitary pads or tampons more than hourly11; or passage of clots >1.1 inch in diameter.11

  • Recurrent miscarriage may be a feature of some congenital factor (eg, factor XIII) and fibrinogen deficiencies.10

  • Arterial or venous thromboses may be a feature of some congenital factor (eg, factor XI, factor VII, fibrinogen, factor V, and factor XIII) deficiencies.9

  • NSAID, nonsteroidal anti-inflammatory drug; OTC, over the counter.