A. Are there any identifiable factors that predispose patient to bleeding? For example, an underlying infection causing disseminated intravascular coagulation (DIC)?
B. Pertinent Past Medical History: Is there a history of liver disease? Any previous history of bleeding? A previous history of easy bruising in the first year of life raises suspicion of a bleeding disorder. Inquire about nutritional status. Vitamin K deficiency can result from malabsorption syndromes or malnutrition.
C. Pertinent Past Surgical History: Has patient had bleeding with past procedures? Approximately 30% of male infants with hemophilia bleed during circumcision.
D. Pertinent Family History. Attempt to characterize bleeding in relatives. Most patients with a family history of hemophilia are diagnosed at birth. However, one third of hemophiliacs represent new mutations.
E. What medication(s) does patient take? Aspirin and NSAIDs affect platelet function but typically do not cause bleeding unless patient has an underlying defect in hemostasis.
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