Approach to Bleeding in the Hospitalized Patient.

Excessive bleeding is relatively common in adult inpatients, whether as the primary reason for admission or developing during the hospital stay. Common causes include structural issues, medication effects and systemic illnesses but occasionally unexpected bleeding can develop as a result of an undiagnosed or newly acquired bleeding disorder. The first step in caring for the bleeding inpatient is to determine whether the bleeding symptom is truly new or if the patient has a past history of abnormal bleeding. Patients with a history of abnormal bleeding may warrant evaluation for inherited bleeding disorders, such as platelet function disorders, von Willebrand disease, hemophilia or rare factor deficiencies. Patients with no history of bleeding, for whom other causes, such as liver dysfunction, medication effect, disseminated intravascular coagulation or certain vitamin deficiencies have been ruled out may require evaluation for acquired coagulopathies, such as acquired hemophilia or acquired von Willebrand disease. Here we present three cases to discuss the diagnosis and management of the two most common acquired bleeding disorders, as well as a congenital bleeding disorder patient with a historical diagnosis.