title: First-Step Results of Children Presenting with Bleeding Symptoms or Abnormal Coagulation Tests in an Outpatient Clinic.
abstract: OBJECTIVE
  Mild bleeding symptoms are commonly seen in the general population. The aim of this study was to determine the final clinical and laboratory features of children referred for a first evaluation with a suspected bleeding disorder in the pediatric outpatient clinic of İstanbul University.
  
  
  METHODS
  The medical records of 26,737 outpatients who were admitted to the Division of Ambulatory Pediatrics between 31 October 2011 and 31 October 2012 were evaluated retrospectively. Ninety-nine patients were initially diagnosed as having probable bleeding disorders and were followed up. The symptoms of bleeding in addition to coagulation tests were analyzed.
  
  
  RESULTS
  Of the 99 patients, 52 (52.5%) were male and 47 were female, and the mean age of the entire study group was 9.1±4.1 years (minimum-maximum: 2-18 years). Major bleeding symptoms were epistaxis in 36 patients (36.4%), easy bruising in 32 (32.3%), and menorrhagia in 6 (6.1%). After initial tests ordered by the pediatrician, 36 of 99 patients (36.4%) were diagnosed as having bleeding disorders that included von Willebrand disease in 12 (12.1%), hemophilia A or B in 9 (9.1%), and other rare factor deficiencies in 9 (9.1%). Six patients (6.1%) were found to have combined deficiencies. Seven of 36 patients had a family history of bleeding.
  
  
  CONCLUSIONS
  Among the patients referred for bleeding disorders, 36.4% were diagnosed with a bleeding disorder with the help of primary screening tests ordered in the outpatient clinic.
authors.affiliation: İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Division of Ambulatory Pediatrics, İstanbul, Turkey Phone: +90 212 414 20 00 E-mail: drismail810@yahoo.com.
authors.forename: İsmail
authors.initials: İ
authors.lastname: Yıldız
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Ünüvar
authors.forename: İbrahim
authors.initials: İ
authors.lastname: Kamer
authors.forename: Serap
authors.initials: S
authors.lastname: Karaman
authors.forename: Ezgi
authors.initials: E
authors.lastname: Uysalol
authors.forename: Ayşe
authors.initials: A
authors.lastname: Kılıç
authors.forename: Fatma
authors.initials: F
authors.lastname: Oğuz
authors.forename: Emin
authors.initials: E
authors.lastname: Ünüvar
mesh_terms: D000293:Adolescent; D025861:Blood Coagulation Disorders, Inherited / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D020147:Coagulation Protein Disorders / Q000175:diagnosis; D003288:Contusions / Q000209:etiology; D042241:Early Diagnosis; D004844:Epistaxis / Q000209:etiology; D005260:Female; D006467:Hemophilia A / Q000175:diagnosis; D006474:Hemorrhagic Disorders / Q000097:blood / Q000209:etiology*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital; D010372:Pediatrics; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology; D014842:von Willebrand Diseases / Q000175:diagnosis