Practice tips

• A careful history and physical examination will usually pinpoint the cause of the bleeding disorder.

• Drug therapy can lead to unmasking of preexisting haemostatic disorders, e.g. platelet dysfunction induced by aspirin may cause spontaneous bleeding in patients with underlying von Willebrand's disease.

• Think of DIC in any acutely ill patient with abnormal bleeding from sites such as the mouth or nose, venepuncture or with widespread ecchymoses. The clinical situations are numerous, e.g. septicaemia, obstetric emergencies, disseminated malignant disease, falciparum malaria, snake bites.

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Dealing With Back Pain

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