By Craig S. Kitchens MD, Craig M. Kessler MD, Shearer, Edith J. Applegate
This functional new source is helping readers deal with the entire variety of clotting and bleeding issues speedy and successfully. Written through a crew of revered clinicians, it examines indicators, laboratory findings, analysis, differential analysis, and remedy. A reader-friendly layout and 1000's of illustrations make it a vital device for busy physicians.The first strictly scientific source at the analysis and remedy of clotting and bleeding issues. contains a bankruptcy at the consultative approach in addition to insurance of the interface of hematology with cardiology, oncology, bloodbanking, pharmacology, and extensive care medication. provides a complete part on women's concerns, such as analyses of OCPs/estrogen treatment, bleeding with being pregnant, and antiphospholipid syndrome and being pregnant. Examines the influence of HIV, outpatient anticoagulation, persistent venous insufficiency, inferior vena cava filters, and different matters in a piece on detailed issues. Clarifies laboratory protocols, aiding readers opt for and interpret lab checks extra simply. provides the fundamental technology physicians have to perform successfully.
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Extra resources for Consultative Hemostasis and Thrombosis
The former is illustrated by such pathologic states as TTP, idiopathic thrombocytopenic purpura (ITP), and hemolytic disease with considerable erythrocyte fragmentation. Essentially, cellular debris and fragments may be counted as platelets, resulting in overestimation of the platelet count. , Bernard-Soulier syndrome, Mediterranean megathrombocytopenia syndrome, myeloproliferative diseases) and may yield spuriously low counts. The problems of counting imprecision in the low thrombocytopenic range appear to be minimized by the use of direct or indirect immunologic counting methods with monoclonal autoimmune thrombocytopenic purpura, however, BT may remain normal despite a significant quantitative deficiency.
Accordingly, many causes of prolongation of the PTT have been proposed. Some of these causes are of hemostatic importance, and others are not. No correlation has been made between the degree of prolongation of the PTT and hemorrhagic potential; rather, it is the cause of the prolongation that determines the risk. A prolongation of 20 seconds due to lupus anticoagulant (LA) is of no hemorrhagic risk, but an 8-second prolongation due to mild hemophilia A with 8% factor VIII activity represents extreme risk for bleeding with a surgical procedure.
The definition of “easy bruisability” is entirely subjective; both terms should therefore be qualified with and substantiated by objective physical findings (see Chapter 11). Suspicious lesions include those that develop spontaneously or with minimal trauma and those that are located over the torso rather than on the extensor surfaces of the extremities. If a patient develops a painful eschar while on warfarin, the possibility of warfarin-induced skin necrosis, a prothrombotic disorder associated with warfarininduced deficiencies of protein C or protein S, should be considered.