Application of Indicators, Predictors and Diagnostic Indices in Coagulation Disorders

Hemodynamic Instability after Low-Energy Thigh Contusion Caused by Injury to the Femoral Artery: A Case Report and Literature Review

Acute vascular injuries have been described in relation to high-energy trauma accidents or in patients undergoing surgery in the femoral area. We describe a healthy patient who sustained a direct, low-energy contusion in the thigh and presented haemodynamic instability. Arteriography was used to locate the point of bleeding, and embolisation and vessel occlusion were carried out to stop the haemorrhage. The genetic study identified the COL3A1 gene mutation; accordingly, the patient was diagnosed with the Ehlers-Danlos syndrome type IV (vascular type).

Pre-operative hemostatic assessment and management

Excessive surgical bleeding can be predicted and then prevented in most patients with a recognised hereditary bleeding tendency or in those on anti-thrombotic therapy. However the clinical consultation of an individual patient can be challenging because the diagnosis can be unclear or a balance needs to be achieved between minimising bleeding without precipitating thrombosis. Laboratory testing does provide assistance in assessment of a bleeding tendency but it is not uncommon for the results to be inconclusive. Investigations such as the level of von Willebrand factor assays should be regarded as a continuous risk factor for surgical bleeding rather than defining a disease category. Appropriate replacement therapy prior to surgery is effective in preventing surgical bleeding. Aggressive anti coagulant therapy around the time of surgery in patients who usually are on warfarin more often lead to unnecessary haemorrhage rather than preventing further thrombosis. A risk assessment of both bleeding versus thrombosis for the particular operation is necessary to ensure the best outcome.

The etiology of thrombocytopenia

Hemostasis depends on an adequate number of well-functioning platelets in the circulating blood; decreasing platelet levels raise the risk for bleeding. Thrombocytopenia is a laboratory finding, not a diagnosis, and once identified, a detailed history, physical examination, and further laboratory tests are used to establish an etiology. This article reviews the assessment, diagnosis, and treatment of thrombocytopenia.

Carriers and noncarriers of haemophilia A. Evaluation of bleeding symptoms registered by a self-administered questionnaire with binary (no/yes) questions

Carriers of haemophilia A were recently described to have significantly more bleeding symptoms than healthy females. Eighteen obligate carriers and 20 females classified as carriers with approximately 95% confidence, as described in an accompanying paper, were compared with 56 noncarriers with respect to ten bleeding symptoms, registered by a questionnaire. A rank-order of negative findings indicating noncarrier state is presented, as well as a rank order of positive findings indicating carrier state. A summation index of the total diagnostic capacity of the ten questions shows that carriers have more bleeding symptoms than healthy females.