Bleeding tendency may be caused by a defect in primary hemostasis, caused by thrombocytopenia (TabJeJ.) or thrombocytopathia (e.g. von Willebrand's disease, non-steroidal anti-inflammatory drugs, uremia). Defects in secondary hemostasis result from deficiency of coagulation factors or from the development of inhibitors against coagulation proteins (Ta.b.le.1). There is no evidence in the literature for a predictive value of the bleeding time for the occurrence of bleeding. For this reason the test should be used with great caution. However, in a case of a documented defect in primary hemostasis, the bleeding time may be useful for monitoring the effect of a therapeutic intervention, e.g. administration of deamino-D-arginine vasopressin or von Willebrand factor. If the general coagulation screening tests remain normal in a bleeding patient, a factor XIII deficiency should be considered.
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