Unexplained bleeding

There has been a change to the APTT coagulation screen reagent used in Lothian.

THIS MAY AFFECT INTERPRETATION OF RESULTS: SOME MINOR (OR EVEN NO) PROLONGATION IN APTT CAN STILL BE ASSOCIATED WITH CLOTTING DISORDERS AND THE CLINICAL PICTURE IS KEY.

PLEASE SEE OUR MARCH 2025 APTT GUIDANCE FOR MORE INFORMATION.

If referring, please give a concise clinical history outlining when the bleeding occurred, any contributing factors, medication etc.

Please see details of medication which can cause unexplained bleeding under ‘who not to refer’.

C.M & L.W 31-07-23

Who to refer:

Please refer individuals with:

Unexpected and significant bruising or bleeding, spontaneous or provoked (eg trauma, surgery)
Family history of a bleeding tendency/ disorder
Significant menorrhagia from menarche

Who not to refer:

Patients with site-specific bleeding e.g. gastrointestinal, genitourinary, epistaxis may be more appropriately referred to the relevant specialty first.
Minor increase in bruising after starting drug with known antiplatelet action, e.g. aspirin, clopidogrel, fluoxetine.
Menorrhagia after teenage years as sole bleeding manifestation: refer to gynaecology first
If restricted diet and increased bruising / minor oral bleeding only, give trial of vitamin C replacement as per BNF before referring.