Category Archives: Inherited bleeding

Case 76 – update 3

Our patient is started on recombinant factor VIII replacement and achieves a trough level of 100%. Neurosurgery is not required. Genetic samples are sent to examine the F8 gene to see where the mutation is as this can help investigate … Continue reading

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Case 76 – update 2

Factor assays are back. IX, XI and XII are within normal limits for neonates but VIII is <1%. This confirms the diagnosis of severe haemophilia A.   The child is transferred to the regional haemophilia centre for intensive VIII replacement … Continue reading

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Case 76 – update 1

Our three day old child is admitted unwell and has deranged clotting with a markedly prolonged APTT. The team wanted an ultrasound scan which confirms a small intraparenchymal bleed. Repeat coagulation testing shows: PT 18s (12-14 adult) APTT 92s (30-38 … Continue reading

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Case 76 – the beginning

You are working in the emergency department of a district general hospital. Parents bring a three day old child in for assessment as he has been non-specifically unwell, looking pale and feeding poorly. He was born at term by spontaneous … Continue reading

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Case 74 – summary

Thankyou for your input this week!This week we had a look at a few abnormalities that can be seen on coagulation screens in a pre procedure setting. The first thing to say is there is no replacement for a good … Continue reading

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Case 74 – part 2

So our second case starts with a phone call from the anaesthetic consultant in the pre op clinic. He has a 20 year old man that needs a wide excision of a suspicious mole on his back.  He has been … Continue reading

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Case 74 – part 1

Welcome to our new teamhaem cases!This week we will run through some short cases with pre operative coagulation screen abnormalities! Our first patient is a 25 year old male who has been admitted to the surgical assessment unit with abdominal … Continue reading

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Case 64 – part 2 – summary

The main aim of this case was to remember that the coagulation screen alone is not suitable for ruling out a bleeding disorder. The most common inherited bleeding disorder frequently will have a normal clotting screens. Indiscriminate clotting screens are … Continue reading

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Case 64 – part 2b

Further questioning of our pre-operative patient reveals she has easy bruising without trauma and has required cauterisation for epistaxis in the past. She bled after a tooth was removed and had to see the dentist following the procedure due to … Continue reading

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Case 64 – part 2a

A 31 year old female is in pre-assessment clinic for an elective laparoscopic cholecystectomy for gallstones. She has no other major medical problems although she does say that she bruises easily after trauma. She also has heavy periods which are managed … Continue reading

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Case 64 – part 1 – summary

We started with a 72 year old gentleman who was having an elective pacemaker insertion. He had an isolated prolonged APTT and we have previously used the following flow chart to make a diagnosis:   It should be remembered that … Continue reading

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Case 64 – part 1c

Our patient has a long APTT and has a haematoma and extensive bruising following pacemaker insertion. He is not on any anticoagulation, but does not have any previous clotting screens to compare to. Given the bleeding history, FFP is administered … Continue reading

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Case 64 – part 1b

The patient with abnormal clotting resulst goes ahead with his planned pacemaker insertion. There is no major bleeding during the procedure but afterwards there is a large haematoma around the pocket with extensive bruising.   Repeat clotting screen shows: PT … Continue reading

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Case 64 – part 1a

This week we’re going to present a series of short cases around clotting results. Hopefully we’ll demonstrate when coagulation screens should be used and also how to interpret basic abnormalities. It most be noted that different labs will use different … Continue reading

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Case 37 part 3 – summary

Our patient was unwell with pneumonia. The results showed an isolated prolonged APTT: PT 14s (11-14s) APTT 48s (33-40s) APTT 50:50 mix 47s Fibrinogen (Clauss) 4.9g/L (1.5-4.5g/L) Thrombin time 16s (15-19s) She was not on any anticoagulation and had no … Continue reading

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Case 37 part 3 – update 1

The patient is rather unwell with a community acquired pneumonia and requiring supplemental oxygen and intravenous antibiotics. She is not ‘septic’ with low BP etc. There is no history of bleeding and the coagulation screen 5 years pre knee operation … Continue reading

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Case 37 part 3 – the beginning

Welcome back. Case 37 has focused around an abnormal APTT. This is a common finding in the routine coagulation screen. It is important to investigate appropriately to avoid delayed procedures and patient anxiety. The first case had a factor XII … Continue reading

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Case 37 part 2 – summary

The key to this mini case was the history. The patient had had numerous previous operations without problems. Therefore inherited bleeding disorder is unlikely. The clotting screen had previously been normal so an acquired problem is what we’re dealing with. … Continue reading

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Case 37 part 1 – summary

Our patient has factor XII deficiency. Factor XII is needed in the activation of the clotting cascade when measuring the APTT in the laboratory (via contact factor). However it is not required in life to activate clotting. Hence people do not … Continue reading

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Case 37 part 1 – update 2

Our patient who is pre-op has had a routine coagulation screen has a prolonged APTT which corrects on mixing with normal plasma, indicating a possible coagulation factor deficiency. If the APTT does not correct it would suggest an antibody interfering … Continue reading

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