6. 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?