What questions should you ask when you screen a patient for potential bleeding problems and what laboratory tests should you order?

What questions should you ask when you screen a patient for potential bleeding problems and what laboratory tests should be ordered if a bleeding problem is suspected?

Your best screening procedure for a bleeding disorder is a good medical history.

If the review of the medical history indicates a bleeding problem, then, a more detailed history is needed.

The following questions are basic:

1. Is there a family history of bleeding problems?
2. Is there excessive bleeding after tooth extractions or other surgeries?
3. Has there been excessive bleeding after trauma, such as minor cuts and falls?
4. Is the patient taking any medications that affect bleeding, such as aspirin, commonly prescribed anticoagulants (e.g., warfarin [Coumadin], enoxaparin [Lovenox], heparin), herbal medications, or antibiotics?
5. Does the patient have any known illnesses that are associated with bleeding (e.g., hemophilia, leukemia, renal disease, liver diseases, and cardiac diseases)?
6. Has the patient ever had spontaneous episodes of bleeding from anywhere in the body?

Lab tests:

• Platelet count: normal values = 150,000-400,000/μL
• Prothrombin time (PT): normal value = 10-13.5 seconds
• International normalized ratio (INR): normal value = 1-2 (only useful for those patients on known anticoagulant medications)
• Partial thromboplastin time (PTT): normal value = 25-36 seconds
• Thrombin time (TT): normal value = 9-13 seconds
• Bleeding time: normal value ≤ 9 minutes (bleeding time is a nonspecific predictor of platelet function)

Normal values may vary from one laboratory to another. It is important to check the normal values for the laboratory that you use. If any of the tests are abnormal, the patient should be referred to a hematologist for evaluation before treatment is performed.

Source: Dental Secrets, Elsevier, 2015