Unexplained bleeding

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.

How to refer:

SCI gateway to the Department of Haematology BGH

Primary care investigations

• FBC and blood film
• Coagulation screen
• LFTs, U&Es, thyroid function tests
• Protein electrophoresis and urine Bence-Jones protein if >40 years old.