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Laboratory evaluation of a bleeding patient.
The Western Journal of Medicine
|January 1, 1989
Summary
Diagnosing abnormal bleeding typically involves a complete blood count and clotting tests. Further specialized tests may be needed for complex cases like disseminated intravascular coagulation or von Willebrand
Area of Science:
- Hematology
- Clinical Pathology
Background:
- Abnormal bleeding is a common clinical concern with diverse etiologies.
- Accurate diagnosis is crucial for effective patient management and treatment.
Purpose of the Study:
- To outline the diagnostic approach for abnormal bleeding.
- To highlight key laboratory tests and potential diagnoses.
Main Methods:
- Initial evaluation includes complete blood count (CBC) with platelet count.
- Coagulation screening involves bleeding time, prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT).
- Advanced testing may assess factor XIII function, fibrinolysis, and vascular integrity.
Main Results:
- Standard coagulation tests identify most causes of abnormal bleeding.
- Specific conditions like disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), and von Willebrand's disease require targeted investigations.
- Other potential diagnoses include vitamin K deficiency, heparin-induced thrombocytopenia, acquired factor VIII inhibitors, lupus anticoagulants, and HIV-related coagulation disorders.
Conclusions:
- A stepwise diagnostic algorithm utilizing CBC and coagulation profiles is effective for abnormal bleeding.
- Complex cases necessitate specialized assays to confirm specific hemostatic defects.
- Comprehensive testing aids in differentiating various bleeding disorders, guiding appropriate therapy.