It is critical to distinguish hereditary hemorrhagic disorders from acquired disorders. Therefore, questions about bleeding at circumcision, bleeding after surgery, and especially bleeding during dental extractions are helpful. Absence of significant bleeding at the time of removal of impacted wisdom teeth is strong evidence against congenital hemorrhagic disorders. Petechial bleeding suggests thrombocytopenia or vascular disorders and is apt to occur on the lower legs or on the buccal membranes. Mucosal bleeding can result from thrombocytopenia or warfarin overdose.
Deep tissue bleeding, typically in the form of hemarthroses, is seen in hemophiliacs.
A problem arises in identifying aspirin as the cause of a hemorrhagic disorder because several hundred formulations contain aspirin, but very often, the name of the preparation provides no clue as to its aspirin content. In patients with thrombotic disorders, the history should focus on smoking habits and hypertension, as well as thromboses after childbirth, surgery, and orthopedic procedures. Other important clinical clues to the diagnosis include a history of use of estrogen-containing oral contraceptives, a family history of recurrent venous thromboembolism, or thromboembolism beginning in youth. An atypical site of thrombosis suggests the existence of an underlying hypercoagulable state.