Essentials for Diagnosis 
(1) The patient has a history of suffering from some diseases in which bleeding is frequently seen. For instance, hemoptysis is indicative of a history of diseases of the pulmonary system, such as chronic cough, dyspnea due to retention of sputum, and tuberculosis; hematemesis and hemafecia are indicative of a history of stomachache, hypochondric pain, jaundice and abdominal mass.

(2) There may be different symptoms with bleeding from different areas of the body. For instance, epistaxis is manifested as bleeding from nasal cavity; gingival hemorrhage is manifested as bleeding from the dental diastema and gum; hemoptysis is manifested as spitting of blood by coughing, or itching of the throat and feeling of oppression over the chest, followed by coughing up bright red blood with foam, or blood-stained sputum; hematemesis is manifested as spitting of brown or dark purple blood by vomiting often with food residue from the stomach, and accompanied by pitch-black stools; hemafecia is manifested as discharge of bloody stools in bright red or dark red color, even as black as tar; hematuria is manifested as blood or blood streak in the urine; hemokelidosis is manifested as bluish purple spots which are as small as pinholes or become confluent to form a patch on the skin and do not fade on pressure.

(3) The following examinations are recommended to help ascertain the causes of hemorrhagic syndrome. They are blood and urine routine examinations, fecal occult blood test, platelet count, bleeding and coagulation times, vasoconstrictive time, prothrombin time, capillary fragility test, bone marrow smear, gastrofiberscopy, barium meal radiography of the upper digestive tract, ultrasonography (B mode), X-ray examination of chest, bronchoscopy or bronchography, and computerized tomography of chest and abdomen.

(4) Hemorrhagic syndrome should be differentiated from physiological hemorrhage. Retrograde menstruation may cause epistaxis, which is closely related with menstrual cycle and often occurs ahead of or during menstrual cycle.