Case 37 part 1 – update 1

The history is frequently forgotten when worrying about coagulation tests and it is the most important factor. The patient was contacted the next day and he confirms that he has no bleeding problems and is on no medications.  He has no past history of excess bleeding. There are no previous coagulation results. If you’re wondering what sort of questions to ask from a bleeding history here will give you an idea:

  • Epistaxis – mild/moderate/severe? Needing packing? Needing transfusion?
  • Cutaneous bleeding/bleeding from minor wounds
  • GI bleeds – needed admission/transfusion/endoscopy
  • Tooth extraction – required sutures/packing/exploration
  • Surgery – excessive bleeding/transfusion
  • Menorrhagia – requiring OCP/TXA/Coil, hysterectomy
  • Post partum haemorrhage
  • Muscle/joint bleeds
  • CNS bleeds
  • Family history of bleeding or bleeding disorder

The sample is repeated and reveals similar results:

  • PT 12s (11-14s)
  • APTT 45s (33-40s)
  • Fibrinogen (Clauss) 3.4g/L (1.5-4.5g/L)
  • APTT (50:50 mix) 33s – i.e. fully corrects

Questions:

  • What test(s) do you do next?
  • Can the patient have the operation?

Please reply to us (@teamhaem) on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion and learning.

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