A medical history taking and physical examination are vital, since many different
conditions can produce similar laboratory abnormalities. For example, end-stage
liver failure and disseminated intravascular coagulation produce thrombocytopenia
and similar changes in standard tests of coagulation, and yet the management of
and prognosis for these conditions are very different. A peripheral-blood smear is
a vital investigation tool in most cases to confirm a low platelet count and the presence
or absence of other diagnostic features, such as red-cell fragmentation, platelet
morphologic abnormalities, or evidence of dysplasia or hematinic deficiency.
Table 1 and Figure 1 highlight the relationship between laboratory findings and
various coagulopathies.
Once it has been determined that the underlying cause is not a response to
therapeutic agents meant to modify the coagulation response (e.g., treatment with
vitamin K antagonists, heparinoids, or direct factor Xa or IIa inhibitors), practitioners
need to evaluate the pattern of bleeding, which may include widespread petechiae
and mucosal bleeding in platelet disorders, generalized oozing from de-epithelialized
surfaces, and fast bleeding from damaged major vessels.
A medical history taking and physical examination are vital, since many differentconditions can produce similar laboratory abnormalities. For example, end-stageliver failure and disseminated intravascular coagulation produce thrombocytopeniaand similar changes in standard tests of coagulation, and yet the management ofand prognosis for these conditions are very different. A peripheral-blood smear isa vital investigation tool in most cases to confirm a low platelet count and the presenceor absence of other diagnostic features, such as red-cell fragmentation, plateletmorphologic abnormalities, or evidence of dysplasia or hematinic deficiency.Table 1 and Figure 1 highlight the relationship between laboratory findings andvarious coagulopathies.Once it has been determined that the underlying cause is not a response totherapeutic agents meant to modify the coagulation response (e.g., treatment withvitamin K antagonists, heparinoids, or direct factor Xa or IIa inhibitors), practitionersneed to evaluate the pattern of bleeding, which may include widespread petechiaeand mucosal bleeding in platelet disorders, generalized oozing from de-epithelializedsurfaces, and fast bleeding from damaged major vessels.
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