APPROACH TO THE DIAGNOSIS AND MANAGEMENT OF MILD BLEEDING DISORDERS
Abstract number: SOA-S-003
Greaves1 M., Watson1 H.G.
1School of Medicine, Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen, United Kingdom
How-to-cite Greaves M, Watson HG. APPROACH TO THE DIAGNOSIS AND MANAGEMENT OF MILD BLEEDING DISORDERS. J Thromb Haemost 2007; 5 Supplement 2: SOA-S-003
Symptoms suggestive of the presence of a mild bleeding tendency are commonplace. Whilst the majority with such symptoms are healthy, it is important to identify those with bleeding disorders in order to manage symptoms, to minimise risk from invasive procedures and to avoid unnecessary exposure to blood products.
Thorough clinical assessment remains the cornerstone of the diagnostic strategy for mild bleeding disorders, although the sensitivity and specificity of the clinical history and examination are limited. When clinical suspicion is aroused the use of a staged protocol of laboratory investigations is appropriate, but the limitations of currently available tests of primary haemostasis and blood coagulation must be recognised if diagnostic errors are to be avoided. Whilst there is considerable current interest in global assays of haemostasis and coagulation none has yet been demonstrated conclusively to be more effective than the more standard approach.
Iatrogenic bleeding has increasing prominence in clinical practice. The expanding use of anticoagulants and platelet inhibitor drugs has resulted in an increased proportion of the population being at risk of abnormal bleeding. Knowledge of the levels of risk associated with particular drugs and combinations, and the advantages and hazards of interruption of drug use for planned interventional procedures, are essential in order to reduce the incidence of iatrogenic bleeding.
Prevention and treatment of haemorrhage in subjects with mild bleeding disorders includes the application of general measures, including attention to surgical technique, measures specific to the precise diagnosis, and less specific treatments which enhance haemostasis and coagulation or inhibit fibrinolysis. The last of these includes the widely-prescribed drugs desmopressin, aprotinin, epsilon aminocaproic acid and tranexamic acid. Data are now available on their efficacy and safety in a range of clinical situations.
To cite this abstract use the following format:
Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number
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