Page 372 - Essential Haematology

358 / Chapter 26 Coagulation disorders

Table 26.6 Haemostasis tests: typical results in acquired bleeding disorders.
Activated partial
thromboplastin
Platelet count Prothrombin time time Thrombin time
Liver disease Low Prolonged Prolonged Normal (rarely
prolonged)
DIC Low Prolonged Prolonged Grossly prolonged
Massive Low Prolonged Prolonged Normal
transfusion
Coumarin Normal Grossly prolonged Prolonged Normal
anticoagulants
Heparin Normal (rarely low) Mildly prolonged Prolonged Prolonged
Circulating Normal Normal or Prolonged Normal
anticoagulant prolonged

DIC, Disseminated intravascular coagulation.

Treatment
Treatment of the underlying cause is most impor- Table 26.7 Indications for the use of fresh

tant. The management of patients who are bleeding frozen plasma (National Institutes of Health

differs from that of patients with thrombotic Consensus Guidelines).
problems.
Coagulation factor defi ciency (PCC where
Bleeding specifi c or combined factor concentrate is not
Supportive therapy with fresh frozen plasma (Table available)
26.7 ) and platelet concentrates is indicated in Reversal of warfarin effect (PCC if available are
patients with dangerous or extensive bleeding. highly effective compared to plasma which has
Cryoprecipitate provides a more concentrated almost no effect)

source of fibrinogen and red cell transfusions may
Multiple coagulation defects (e.g. in patients
be required.
with liver disease, DIC) (PCC are much better,
plasma is virtually useless)
Thrombosis

The use of heparin or antiplatelet drugs to inhibit Massive blood transfusion with coagulopathy
the coagulation process is considered in those with and clinical bleeding
thrombotic problems such as skin ischaemia. Thrombotic thrombocytopenic purpura
Fibrinolytic inhibitors should not be considered

Defi ciencies of antithrombin * , protein C * or

because failure to lyse thrombi in organs such as the
protein S
kidney may have adverse effects. Antithrombin con-

centrates or recombinant activated human protein Some patients with immunodefi ciency
C may be used to inhibit DIC in severe cases with syndromes
sepsis (e.g. meningococcal septicaemia). Th ere is
reduced activated protein C (APC) in severe sepsis DIC, disseminated intravascular coagulation; PCC,
prothrombin complex concentrates.
and recombinant human APC has been found to
* Antithrombin and protein C concentrates now available.
reduce mortality in this setting.