Page 595 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

CHAPTER 28 ■ Disorders of Hemostasis and Thrombosis: Blood Coagulation Factors, Hypercoagulable State, and Anticoagulant Therapy 579

CASE STUDIES

Case Study 28.1 ■ Laboratory Data
On a ission, the he og obin an he atocrit were 15.0
A 2-year-o boy e ro a backyar gy set. His shou - g/L an 44%, res ective y. T e P was 13 secon s (nor a ,

er an u er ar beca e very swo en short y a er the 10 to 15 secon s), an the AP was 55 secon s (nor a ,

a . T e boy’s other took hi to the e ergency e art- 28 to 35 secon s).

ent a ew hours a er the inci ent because he was co -

aining o ain. On hysica exa ination, the hysician Because o the resu ts obtaine on the origina an a re eat

note that a arge he ato a ha or e in the u er art s eci en o the AP in conjunction with a vague a -

o the boy’s right ar . T ere was no history o surgery (he i y history o b ee ing, this atient’s surgery was ost one

ha not been circu cise ), injury, or i ness. T e boy was unti a b ee ing isor er cou be ru e out.

receiving no e ication. ■ Critical Thinking Group Discussion Questions

E ergency e art ent treat ent consiste o as irating 1. What coagu ation e ciencies ight be resent in this

the he ato a. Subsequent to this treat ent, the boy began atient?

to b ee extensive y. He was a itte to the hos ita .

T e o owing S A aboratory tests were or ere : a 2. What su e entary aboratory assays wou be a ro-

he og obin an he atocrit, ate et count, an b ee ing riate?

ti e. Because the b ee ing continue , a ty e an cross atch

or two units o resh b oo were or ere on a stan by basis. 3. How cou this be istinguishe ro other si i ar is-

A itiona in or ation ro the other revea e that or ers?

the boy’s cousin ha a “b ee ing rob e .” Case Study 28.3

■ Laboratory Data A 62-year-o white an with a history o abnor a b ee -
He og obin 8.0 g/L ing was a itte to the hos ita or a e ica worku

He atocrit 26% be ore enta surgery. A brother ha ie at age 19 o trau-

P ate et count 200 × 10 /L (nor a , 150 to 450 × 10 /L) atic b ee ing a er being injure in a car acci ent.
9
9
B ee ing ti e 5 inutes (nor a , 3 to 8 inutes)

Subsequent coagu ation ro e tests were or ere be ore T e atient ha his rst b ee ing e iso e at 7 years o age

the trans usion o two units o resh who e b oo . T e o owing a y h no e resection. He re orte having sig-

resu ts o these tests were as o ows: ni cant he orrhaging as a teenager o owing i trau a.
At age 30, the atient ha a tooth extraction o owe by 3

P 12 secon s (nor a , 11 to 15 secon s) weeks o b ee ing, at which ti e he receive a b oo trans-

AP 60 secon s (nor a , 28 to 35 secon s) usion. At age 31, he was given a b oo trans usion be ore

T ro bin ti e-re ti ase etho 20 secon s (nor a , 18 to an a en ecto y an on that occasion ha no b ee ing

22 secon s) whatsoever. wo years be ore a ission, the atient su -

ere ro gastrointestina b ee ing o owing surgery or a
■ Critical Thinking Group Discussion Questions
1. Do the aboratory ata su ort a iagnosis o a isor er hiata hernia. At that ti e, he was given two units o bank

o he ostasis? b oo an two units o resh b oo . B ee ing subsi e an
his subsequent recovery was goo .

2. What ty es o isor ers can be re i inari y i enti e ■ Laboratory Data

by the tests that were er or e ? T e aboratory n ings were as o ows:

3. What con r atory tests ust be one in this case? He og obin 7.0 g/L
He atocrit 23%

P ate et count 498 × 10 /L
9
Case Study 28.2
B ee ing ti e (Ivy) 2 inutes (nor a , ess than 8 inutes)

A 21-year-o b ack rison in ate was a itte to the Who e b oo c otting ti e average 188 inutes (nor a ,

hos ita or the re air o an ab o ina hernia. His hy- ess than 70 inutes)

sician was concerne that strangu ation o the hernia P ate et aggregation nor a

cou occur. T e atient was in extre e y goo hysica AP 53 secon s (contro , 39 secon s)

con ition. He i not re e ber having any unusua i - P 13.8 secon s (contro , 13.3 secon s)

nesses. His a i y history i inc u e inor b ee ing S eci c assays or actors VIII an IX were er or e . T e

rob e s a ong so e o his re atives. eve o activity o actor IX was ess than 5%.

(continued)