Surgical Bleeding

Lisa Arfons, MD and Alvin Schmaier, MD

Case Western Reserve University, Cleveland, OH

Copyright of the American Society of Hematology, 2011. ISSN: 1931-6860.

I. HISTORY

Patient Presentation

You are rounding with the Hematology Consult Service when you receive a phone call from a surgical intern. A 62-year-old female is in the recovery room one hour after a thrombectomy was performed for a right pulmonary artery embolism. Her attending is concerned about the amount of blood draining from her chest tubes and would like her evaluated for a coagulopathy. She has no prior history of a bleeding disorder and she had normal coagulation studies prior to the operation.

What further information should you request regarding the patient's history?

Was she on anticoagulation during her week-long hospitalization or at the time of her operation for the pulmonary embolism?
Was she taking any anti-platelet agents prior to surgery?
Does she have any other medical problems?
Does she have a family history of bleeding disorders?
Has she ever had significant bleeding after a surgical procedure?
What is her occupation?
Is she bleeding from any other sites (e.g., venipuncture sites, incision, ET tube or urinary catheter)?
Did she receive blood products during the peri-operative period?

 

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