6. ER Management

ER Management

• Initial impression: hypovolemic shock due to GU hemorrhage caused by a coagulopathy
  
• One unit of O-neg uncrossmatched packed red cells was given in the ER
  
• Repeat labs: Hct 12.3%, Plt: 227, PT and PTT still > 2 min

Generic coag workup so far:

• Clinical evaluation
  - Age and family history (congenital vs. acquired)
  - Medications (aspirin, NSAIDs)
  - Bleeding pattern (mucosal vs tissue)
  
• Routine screening tests
  - Platelets - count and bleeding time
  - coagulation factors/inhibitors - PT and aPTT

Breakpoint #3

• How would you workup this particular coagulation disorder?
  
• Could the coagulation results represent an artifact? How would you rule out this possibility?