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