The approach to a patient with unexplained serious bleeding uses a series of hemostasis principles to help pinpoint the cause of the problem. Understanding normal hemostasis and using common tests such as the platelet count, the PT and the PTT, will help explain the bleeding and guide therapy for most patients. Every once in a while, a patient presents with a less than classical scenario, and poses a diagnostic and treatment challenge. In this session, we will present three such cases and discuss how we navigated through the possibilities in the differential diagnosis until the bleeding could be explained and managed properly.