Screening for hemostasis during hemorrhagic emergencies |
| |
Authors: | Pier Mannuccio Mannucci |
| |
Institution: | (1) Centro Emofilia e Trombosi Angelo Bianchi Bonomi Istituto di Medicina Interna, Università degli Studi di Milano Ospedale Maggiore, Via Pace 9, 20122 Milano, Italia |
| |
Abstract: | Summary We propose a laboratory screening scheme for the hemostatic system to be adopted during hemorrhagic emergencies in hospital
patients bleeding excessively to the extent of requiring massive blood transfusions. The aim of the screening scheme is to
establish whether excessive bleeding is due to alterations of the hemostatic system or to other causes. Seven tests were chosen
on the basis of their simplicity, rapidity and comprehensiveness in the evaluation of the hemostatic system: the platelet
count, the prothrombin and activated partial thromboplastin times, the thrombin and reptilase times and the assays of plasma
fibrinogen and fibrin(ogen) degradation products. We then attempted to validate the choice of these tests with 172 emergency
cases due to excessive bleeding which led to massive blood replacement. The high frequency of abnormalities of one or more
tests found in this series (93%) indicates the excellent diagnostic sensitivity of the screening scheme in detecting hemostatic
abnormalities. The screening scheme was also useful in the diagnostic work-up of the bleeding disorders most frequently encountered
during hemorrhagic emergencies (disseminated intravascular coagulation, liver disease, unsuspected heparinization and the
hemostatic defect associated with massive blood transfusion).
Presented at the ‘2nd International Symposium on Standardization and Quality Control of Cogulation Tests: Implications for the Clinical Laboratory’, Rome, September 28–29, 1989. |
| |
Keywords: | Disseminated intravascular coagulation Fibrin(ogen) degradation products Liver disease Reptilase time Thrombin time |
本文献已被 SpringerLink 等数据库收录! |
|