Medical Council of Canada

Medical expert

Bleeding, Bruising - 15-1


Some bleeding or bruising, although common, is idiopathic and/or self-limiting (e.g., epistaxis, post-traumatic bruising). However, excessive or spontaneous bleeding/bruising may point to a serious underlying disease, in which case urgent management may be required. Note that bleeding related to major organ systems is covered under other objectives (e.g., , , , ).

Causal Conditions

(list not exhaustive)
  1. Localized bleeding (e.g., epistaxis, laceration)
  2. Hemostasis disorders
    1. Platelet or blood vessels disorders (e.g., von Willebrand disease, collagen disorder, medication-induced)
    2. Coagulation disorders (e.g., factor VIII or vitamin K deficiency, fibrinolysis)

Key Objectives

Given a patient with a bleeding tendency or bruising, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan, recognizing that some presentations are self-limited.

Enabling Objectives

Given a patient with a localized or other bleeding/bruising, the candidate will

  1. list and interpret critical clinical findings, including results of an appropriate history and physical examination performed with a particular attention to
    1. airway and hemodynamic status;
    2. differentiation between various disorders of hemostasis and self-limited and/or idiopathic bleeding (e.g., epistaxis);
  2. list and interpret relevant investigations (e.g., complete blood count, coagulation studies);
  3. construct an effective initial management plan, including
    1. initiating immediate management of bleeding (e.g., nasal packing, IV resuscitaiton if hemodynamically unstable);
    2. providing counselling/education on how to prevent future episodes;
    3. making a determination as to whether specialized care is required.
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