The problem of the bleeding state

The problem of the patient who bleeds excessively or alleges he bleeds abnormally, is a familiar one. In some cases the bleeding state may be obvious, since purpura, easy bruising or excessive haemorrhage direct one's attention to it. Sometimes when there is a local lesion it may be difficult to know whether to ascribe the bleeding to local or general causes. A patient, for instance, who presents with epistaxis, may have a local lesion in the nose or a generalized bleeding disease, or both these conditions. Patients with haematuria, haematemesis or melaena may present similar problems