Bleeding disorders are frequent in intensive care medicine, the most common form being acquired. Trauma, gastrointestinal bleeding, liver failure, hematologic malignancies, and adverse drug reactions play an important role. Moderate to severe hereditary bleeding disorders are usually known prior to the acute disease state, while mild hereditary forms may manifest for the first time in association with the acute stress condition. Generally, proper history taking and structured observation are decisive in order to conduct an appropriate diagnostic workup and initiate logical hemostatic management. One cannot always wait for laboratory results during continuous blood loss or conditions such as hypothermia and acidosis. In such cases, pathophysiological extrapolation of expected hemostatic disturbances is essential for timely hemostatic management.