DIAGNOSIS CHECKLIST
for Bleeding under skin

Why: determines if acute or chronic; acquired or inherited.

Why: purpura ( multiple small hemorrhages into the skin or mucous membranes); petechiae (small pinhead size purpura); ecchymoses ( large purpura).

Why: if palpable it suggests due to an underlying vasculitis affecting small vessels e.g. polyarteritis nodosa; if not palpable it suggests due to a platelet defect.

Why: suggests a disturbance of coagulation.

Why: suggests the presence of a systemic bleeding defect.

Why: if immediate suggests platelet defect; if delayed i.e. 24 hrs after trauma it suggests a coagulation factor deficiency.

Why: e.g. tooth extraction, circumcision, pregnancy - if normal response, suggests an acquired not inherited problem.

Why: may suggest acute Immune thrombocytopenic purpura (ITP) especially in children.

Why: may suggest trauma as cause of bleeding under skin.

Why: Acquired bleeding disorders can occur with liver disease, renal failure, lupus erythematosus and some cancers such as Multiple myeloma, myelofibrosis.

Why: Acquired bleeding disorders may be due to certain prescribed medications e.g. aspirin, non-steroidal anti-inflammatory medication, anticoagulant therapy, thiazide diuretics, chloramphenicol, cancer chemotherapy drugs, gold, heparin, quinine, quinidine, sulphonamides.

Why: Alcoholic cirrhosis can cause an acquired bleeding disorder.

Why: e.g. blood in urine, heavy menstrual periods, bleeding nose, bleeding gums, swollen painful joints, rectal bleeding? - suggests presence of a systemic bleeding defect.

Why: may suggest malignancy such as leukemia.

Why: may suggest lupus erythematosus which can cause an autoimmune thrombocytopenia.

Why: may suggest myeloproliferative cancers that can cause an acquired bleeding disorder or iron deficiency secondary to blood loss.