ABSTRACT
INTRODUCTION Life is associated with the experience of some blood loss. Women are much more familiar with bleeding than men since menses is a regular phenomenon in their life. Abnormal menstruation is frequently the first feature of bleeding disorder and there may be intractable bleeding in adolescence. It is noteworthy that the first patient described by Erik von Willebrand in 1926 died of uncontrollable menstrual bleeding at the age of 13. During pregnancy, the balanced function of blood coagulation allows the normal development of the fetus without maternal hemorrhage or thrombosis, and it restricts blood loss during delivery. Normal hemostasis ensures that all the bleeding episodes are limited to minimal blood loss that will not affect the homeostasis of the whole body. Since bleeding is a common experience, the line between ‘physiological’ blood loss and abnormal bleeding tendency or hemorrhage is sometimes ambiguous. On the other hand, bleeding tendency may reflect either primary alterations of some of the components of the hemostatic system or secondary alterations, induced by an underlying disease or by a treatment. Thus, the exploration of the hemorrhagic diathesis must be polyvalent and must combine classic differential diagnostic procedures such as patient’s personal and family history and clinical examination with either simple or sophisticated laboratory assays that explore all the aspects of the hemostatic system. It should be stressed that a detailed personal and family history and clinical examination is of paramount importance and must precede any laboratory investigation.
