What initial investigations should I perform for a patient presenting with unexplained bleeding and suspected acquired coagulopathy?

For a patient presenting with unexplained bleeding and suspected acquired coagulopathy, the initial investigations should include a full blood count (FBC) to assess for thrombocytopenia or other hematological abnormalities. A coagulation screen including prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen level should be performed to evaluate clotting function. If there is a history or suspicion of a coagulation disorder, specific tests such as von Willebrand factor assays may be considered. Additionally, urgent FBC is recommended to exclude hematological malignancies like leukemia in cases of unexplained bleeding, bruising, or petechiae. Monitoring of the international normalized ratio (INR) is important if anticoagulant therapy reversal is being considered. These investigations help identify the cause of bleeding and guide further management including blood product transfusion or reversal of anticoagulation if needed ¹,²,³.