Clinical clues guide the diagnosis.
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.