Bleeding Disorders
Bleeding Disorders

Bleeding Disorders Diagnosis

Your healthcare provider may diagnose your bleeding disorder, and determine whether it is inherited or acquired, based on your symptoms, risk factors, medical and family history, a physical exam, and diagnostic tests.

Typically, providers screen for bleeding disorders only if you have known risk factors or before certain major surgeries.

Medical history

To help diagnose a bleeding disorder, your healthcare provider may ask you questions such as:

  • Do you have blood in your urine or stool?
  • Does your family have a history of bleeding disorders, bleeding events, or blood clots?
  • Do you have a history of miscarriage or postpartum bleeding?
  • Do you have symptoms of other medical conditions linked to bleeding disorders?
  • How long does your menstrual period last, and how many sanitary pads or tampons do you use per day during your period?
  • How often do you bruise or bleed, and how long does the bleeding last?
  • What prescription or over-the-counter medicines, such as aspirin, do you take?
  • Do your gums often bleed, or do you bleed a lot following dental procedures?

Physical examination

Your healthcare provider may do a physical exam to look for signs of a bleeding disorder, such as bruising or petechiae, and to check for other medical conditions that could lead to bleeding disorders or cause similar symptoms. Depending on the reason for your visit, your provider may also look for signs of bleeding-related complications by looking for swelling and checking your blood pressure, heart rate, and breathing.

Diagnostic tests and procedures

To diagnose a bleeding disorder and whether it may be inherited or acquired, your provider may order some blood tests.

Screening tests

Screening tests can help determine if your blood is clotting properly.

  • A complete blood count (CBC) measures many different parts of your blood, such as red, white blood cells and platelets. If the number of platelets in your blood is low, you may have a platelet disorder instead of a clotting factor disorder.
  • A partial thromboplastin time (PTT) test, also called an activated PTT (aPTT), measures how long it takes blood to clot. It can help determine whether there is a problem with a certain group of clotting factors.
  • A prothrombin time (PT) test also measures how long it takes blood to clot. It can help identify problems with a different group of clotting factors than the PTT test.
  • A mixing test can help determine whether the problem is in the clotting factors or is caused by antibodies blocking the clotting factors, such as with autoimmune disorders or acquired hemophilia.

Clotting factor tests

To determine which bleeding disorder you have, your healthcare provider may order clotting factor tests, also called factor assays or a coagulation panel. A clotting factor test measures the level or the activity of a specific clotting factor in your blood.

  • Von Willebrand factor (vWF) tests measure the amount of vWF in your blood and how well it works to determine which type of VWD you have.
  • Clotting factor VIII tests measure the activity of factor VIII in your blood. If you have very low levels of clotting factor VIII, you may have hemophilia A. The assay can also assess how serious your factor deficiency is, which may help determine what treatment you need.
  • A Bethesda test looks for antibodies that may be blocking factor VIII or IX.
  • Factor XIII antigen and activity assays assess factor XIII deficiency.
  • Genetic testing helps determine whether particular genes may be causing the bleeding disorder. Your provider may refer you or your child to a specialist in genetic testing.

Tests for other medical conditions

Your healthcare provider may do some tests or procedures to check for conditions that can cause acquired bleeding disorders.

  • A liver panel looks for signs of liver damage in your blood and can help determine whether problems in the liver are causing the bleeding disorder.
  • A lupus anticoagulant test checks for antibodies that may be a sign of an autoimmune condition affecting how blood clots.
  • Procedures, such as a pelvic exam, Pap test, ultrasounds , or biopsy of the lining of the uterus, can help look for signs of disorders that can cause heavy menstrual bleeding.

Prenatal screening

If you are diagnosed with a bleeding disorder, your healthcare provider may discuss your risk of passing your condition on to a future child.

Depending on your risk factors, your provider may recommend screening your baby during pregnancy using chorionic villus sampling (CVS), which involves taking a tissue sample from the placenta to test for genetic disorders. If you are a hemophilia carrier and you are pregnant, your provider may offer to use CVS at 9 to 11 weeks to check for the hemophilia gene. Later in pregnancy, or after the baby is born, your provider may do a blood test from the umbilical cord.

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