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