Bleeding and Bruising: Primary Care Evaluation

Am Fam Physician. 2024 Nov;110(5):504-514.

Abstract

Easy bruising and bleeding are commonly seen in primary care. Use of a bleeding assessment tool and a comprehensive history, physical examination, and patient-provided photographs can help identify causes of abnormal bleeding and bruising. Family history can aid diagnosis of a heritable cause. Nonaccidental trauma should be considered, especially in vulnerable populations. Initial laboratory testing includes a complete blood cell count, peripheral blood smear, prothrombin time (PT), international normalized ratio, activated partial thromboplastin time (aPTT), and fibrinogen. Normal PT and aPTT results may indicate a platelet disorder. A normal PT result with a prolonged aPTT result indicates a disorder of the intrinsic coagulation pathway, and a prolonged PT result with a normal aPTT result may indicate a disorder of the extrinsic coagulation pathway. Consultation with a hematologist is recommended when initial evaluation indicates a bleeding disorder or when suspicion remains high despite a normal laboratory workup result.

MeSH terms

  • Blood Coagulation Disorders / diagnosis
  • Blood Coagulation Disorders / etiology
  • Blood Coagulation Tests / methods
  • Contusions* / diagnosis
  • Contusions* / etiology
  • Hemorrhage* / diagnosis
  • Hemorrhage* / etiology
  • Humans
  • Medical History Taking
  • Physical Examination / methods
  • Primary Health Care*