Investigation

• Ensure samples not taken from heparinised line.

• FBC with platelet count and blood film examination.

With normal platelets and coagulation screen bleeding is usually surgical and the patient should be supported with blood and urgent surgical re-exploration undertaken. Platelet function abnormalities may occur with aspirin/NSAIDs, uraemia or extracorporeal circuits. Prolongation of both PT and APTT suggests massive bleeding and inadequate replacement, DIC, underlying liver disease or oral anticoagulants. Disproportionate, isolated increases in either PT or APTR are more likely to indicate previously undiagnosed clotting factor deficiencies. A low platelet count may reflect dilution and consumption from bleeding or DIC if platelets were known to be normal preoperatively.

Treatment

• Low platelets or platelet function abnormalities: Give 1-2 adult doses of platelets stat.

• DIC—give 2 adult doses of platelets are 4 units FFP (10-20 units of cryoprecipitate if fibrinogen low) and recheck PT, APTT and FBC.

• Anticoagulant effect: heparin—reverse with protamine sulphate.

warfarin—reverse with FFP or PCC. 39

• Empirical tranexamic acid or aprotinin may be tried if bleeding continues despite the above.

The decreased solubility of deoxyHbS forms the basis of this test. Blood is added to a buffered solution of a reducing agent e.g. sodium dithionate. HbS is precipitated by the solution and produces a turbid appearance. Note: does not discriminate between sickle cell trait and homozygous disease.

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