Randall Children’s Hospital

• Mild bleeding symptoms are very common in healthy populations. – A complaint of easy bruising or mild bleeding may not require evaluation unless there are concerning historical elements. • There are numerous inherited disorders that can cause abnormal bleeding and bruising, including platelet function disorders, quantitative platelet disorders, factor deficiencies and factor inhibitors [...] • There are also diseases that affect the connective tissue and integrity of the blood vessel, making the skin bruise more easily and vessels more prone to bleed. [...] • Discriminating between inherited vs. acquired or minor vs. high-risk bleeding takes time and, often, serial blood draws. Elicit history regarding patient and/or affected family member Epistaxis (number of events per year and typical duration), bruises (size, association with trauma, involve- ment of the soft tissue [hematoma]), bleeding in the mouth (with tooth loss, dental work, brushing), m [...] Call for phone consultation if any abnormalities, 503-276-9300. [...] Management while awaiting appointment Stop NSAIDs, ibuprofen and aspirin if appropriate. [...] Control menses with hormonal suppression. [...] Urgent (one to two days) • Active GI/GU bleeding, epistaxis > 20 min, deep muscle bleeding, post-circumcision bleeding Within two weeks • Daily epistaxis, menorrhagia with a family history of a bleeding disorder Within one month • Pre-op work-up, bruising with a family history of a bleeding disorder PCP management with phone consult • Asymptomatic girls until menarche with a family history of [...] D., MHA Elissa Pocze, CPNP Ronald Prauner, M.D. Nameeta Richard, M.D. [...] Patricia Vrooman, CPNP Referral process Updated February 2017 Find this and other co-management/referral guidelines online at: www.legacyhealth.org/randallguidelines