History and clinical assessment

• Past history in relation to previous haemostatic challenges e.g. previous surgery, dental extractions. Ask specific questions about whether blood transfusion was required.

• Presence of specific clinical problems e.g. impaired liver or renal function.

• Recent drug history—especially aspirin or NSAIDs which can affect platelet function. Also enquire about cytotoxic drugs and anticoagulants.

• Family history of bleeding problems especially after surgery.

• Nature of the surgery and intrinsic haemorrhagic risks of procedure.

• Whether surgery was elective or emergency (in emergency surgery known risk factors are less likely to have been corrected).

• Check case record or ask surgeon/anaesthetist for information on intraoperative bleeding, technical problems etc.

• Whether surgery involves a high risk of triggering DIC e.g. pancreatic or major hepatobiliary surgery.

• Detailed physical examination is not usually practical but bruising, ecchymoses or purpura should be assessed especially if remote from the site of surgery.

• What blood products have been used and over how long? Transfusion of several units of RBCs over a short period of time will dilute available clotting factors.

• Review preoperative investigation results and other information available in the record on past procedures and/or investigations.

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