How to avoid the mistake in diagnosing incipient critical disorder of haemostasis in an out-patient clinic

Czech version

Authors: P. Kessler
Authors‘ workplace: Oddělení hematologie a transfuziologie Nemocnice Pelhřimov, p. o., přednosta prim. MUDr. Petr Kessler
Published in: Vnitř Lék 2012; 58(7 a 8): 141-145
Category: 60th Birthday prof. MUDr. Miroslav Penka, CSc.

Overview

Critical disorders of haemostasis occur mostly in hospitalized patients; they are usually associated with a serious illness. However, a patient with an early phase of such disorder can visit the office of the general practitioner, hematologist or internist. Every patient with newly emerging bleeding symptoms should be thoroughly investigated with the aim of early detecting of developing critical disorder of haemostasis. The disseminated intravascular coagulation, microangiopathic hemolytic anemia (thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, pre-eclampsia, HELLP syndrome and catastrophic antiphospholipid syndrome), acute leukemia and heparin induced thrombocytopenia are the most important emergent haemostasis disturbances. In patients suffering from these disorders the bleeding tendency is often combined with thrombotic process affecting dominantly the microcirculation. Severe bleeding can be caused also by overdose of anticoagulants or by acquired inhibitors of coagulation factors.

Key words:
bleeding – thrombosis – microangiopathic hemolytic anemia – acute leukemia – heparin induced thrombocytopenia

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