When patients are evaluated for the potential of abnormal bleeding before surgery, the intensity of screening is determined by the hemostatic challenge of the procedure and the likelihood that the patient has an underlying congenital or acquired disorder that would predispose to bleeding. The risk of bleeding associated with the type of surgical procedure ranges from low risk (lymph node biopsies, dental extractions) to moderate risk (laparotomy, thoracotomy, mastectomy) to high risk (neurosurgical, ophthalmic, plastic, cardiopulmonary bypass, prostatic, surgery to stop bleeding). A screening history should reveal if the patient has experienced any abnormal bleeding or bruising, if there is a history of an acquired medical disorder which could affect hemostasis, if family members have bled abnormally, or if the patient is taking any drugs which could interfere with hemostasis. Physical examination can also provide important information about a patient's surgical bleeding risk. Ecchymoses, petechiae, or purpura may suggest a systemic hemostatic defect. Stigmata of chronic liver disease include hepatomegaly, splenomegaly, jaundice, spider angiomas, palmar erythema, and dilated abdominal veins.

The preoperative hemostatic screening recommendations by Rapaport provide a reasonable basis for selecting laboratories for individual patients. Level 1 are patients with a reassuring history who are undergoing surgeries with only minimal potential blood loss such as excisional biopsies or dental extractions.