title: Mild Bleeders: Diagnosis is Elusive in Large Number of Patients.
abstract: BACKGROUND
  Bleeding is a common clinical presentation. Even patients with mild bleeding disorders are extensively investigated for ascertaining the cause. The present study was conducted in order to evaluate the extent of the possibility of diagnosis in mild bleeding disorders.
  
  
  METHODS
  This was a prospective study of patients referred for work up of mild bleeding for a period of 13 months. A complete blood count, peripheral smear examination, Prothrombin time, Partial Thromboplastin time and Thrombin Time, Platelet Aggregometry test, tests for von Willebrand's disease and Platelet Factor 3 availability were measured.
  
  
  RESULTS
  164 patients presented with mild bleeding, in 114 of the patients a single site of bleeding was present. Epistaxis was the most common presentation (39%). Cutaneous bleeding (petechiae and purpura) was the next common site. History of a major bleeding tendency in the family was present only in 11 patients. The investigations showed that VWD (17/164), followed by clotting disorders (CD) mainly mild hemophilia (15/164) were the most common diagnosable cause. There were also 4 cases of hypofibrinogenemia. The disorders of platelets (Platelet function defects/PFD) were the least common (9/164). Rest 123 (75%) patients could not be diagnosed on the basis of these investigations and were labeled as Bleeding disorders - Unclassified (BDC).
  
  
  CONCLUSIONS
  n our study, 75% of the patients with mild bleeding remained undiagnosed even after extensive laboratory workup, thus raising a very pertinent question that is it necessary that all mild bleeders submit to a broad battery of investigations, as the diagnosis continues to be elusive despite extensive workup.
authors.affiliation: Department of Hematology, All India Institute of Medical Sciences, Delhi, India.
authors.forename: Mrinalini
authors.initials: M
authors.lastname: Kotru
authors.affiliation: Department of Hematology, All India Institute of Medical Sciences, Delhi, India.
authors.forename: Deepti
authors.initials: D
authors.lastname: Mutereja
authors.affiliation: Department of Hematology, All India Institute of Medical Sciences, Delhi, India.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Purohit
authors.affiliation: Department of Hematology, All India Institute of Medical Sciences, Delhi, India.
authors.forename: Seema
authors.initials: S
authors.lastname: Tyagi
authors.affiliation: Department of Hematology, All India Institute of Medical Sciences, Delhi, India.
authors.forename: Manoranjan
authors.initials: M
authors.lastname: Mahapatra
authors.affiliation: Department of Hematology, All India Institute of Medical Sciences, Delhi, India.
authors.forename: Renu
authors.initials: R
authors.lastname: Saxena
authors.affiliation: Department of Hematology, All India Institute of Medical Sciences, Delhi, India.
authors.forename: Hara Prasad
authors.initials: HP
authors.lastname: Pati