{"id":4492,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/unexplainedbleeding\/"},"modified":"2025-03-11T13:49:21","modified_gmt":"2025-03-11T13:49:21","slug":"unexplainedbleeding","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/unexplainedbleeding\/","title":{"rendered":"Unexplained bleeding"},"content":{"rendered":"\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-6f8be1ddbe5b7fd416a5c22b8b04597e\"><strong>There has been a change to the APTT coagulation screen reagent used in Lothian.<\/strong><\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-9255b92f4dda3c6c8a070ca90a923715\"><strong>THIS MAY AFFECT INTERPRETATION OF RESULTS: &nbsp;SOME MINOR (OR EVEN NO) PROLONGATION IN APTT CAN STILL BE ASSOCIATED WITH CLOTTING DISORDERS AND THE CLINICAL PICTURE IS KEY.<\/strong><\/p>\n\n\n\n<p><strong>PLEASE SEE OUR <\/strong><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/APTT-Change-in-Detection-Levels-March-2025.pdf\"><strong>MARCH 2025 APTT GUIDANCE<\/strong><\/a><strong> FOR MORE INFORMATION.<\/strong><\/p>\n\n\n\n<p>If referring, please give a concise clinical history outlining when the bleeding occurred, any contributing factors, medication etc.<\/p>\n\n\n\n<p>Please see details of medication which can cause unexplained bleeding under \u2018who not to refer\u2019.<\/p>\n\n\n\n<p><strong>C.M &amp; L.W 31-07-23<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p><strong>Please refer individuals with:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Unexpected and significant bruising or bleeding, spontaneous or provoked (eg trauma, surgery)<\/li>\n\n\n\n<li>Family history of a bleeding tendency\/ disorder<\/li>\n\n\n\n<li>Significant menorrhagia from menarche<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients with site-specific bleeding e.g. gastrointestinal, genitourinary, epistaxis may be more appropriately referred to the relevant specialty first.<\/li>\n\n\n\n<li>Minor increase in bruising after starting drug with known antiplatelet action, e.g. aspirin, clopidogrel, fluoxetine.<\/li>\n\n\n\n<li>Menorrhagia after teenage years as sole bleeding manifestation: refer to gynaecology first<\/li>\n\n\n\n<li>If restricted diet and increased bruising \/ minor oral bleeding only, give trial of vitamin C replacement as per BNF before referring.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>SCI gateway to the Department of Haematology RIE.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Primary care investigations<\/h4>\n\n\n\n<p>FBC and blood film<\/p>\n\n\n\n<p>Coagulation screen<\/p>\n\n\n\n<p>LFTs, U&amp;Es, thyroid function tests<\/p>\n\n\n\n<p>Protein electrophoresis and urine Bence-Jones protein if &gt;40 years old.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\"><\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>There has been a change to the APTT coagulation screen reagent used in Lothian. THIS MAY AFFECT INTERPRETATION OF RESULTS: &nbsp;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<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3981,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[248],"class_list":["post-4492","page","type-page","status-publish","hentry","category-unexplainedbleeding"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/haematology\/bleeding\/unexplainedbleeding\/\" rel=\"tag\">Unexplained Bleeding<\/a>","rttpg_excerpt":"There has been a change to the APTT coagulation screen reagent used in Lothian. THIS MAY AFFECT INTERPRETATION OF RESULTS: &nbsp;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","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4492","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4492"}],"version-history":[{"count":8,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4492\/revisions"}],"predecessor-version":[{"id":23351,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4492\/revisions\/23351"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3981"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4492"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4492"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}