Management of Preoperative Bleeding Disorders–Intraoperative Coagulopathy
The main contributors to hemostasis are the vessel wall (endothelium and subendothelium), platelets and circulating proteins with procoagulant and fibrinolytic activities. The surgeon may be the first to witness abnormal hemostasis and should know how to reach an immediate solution in a timely fashion.
Localized bleeding must be distinguished from diffuse bleeding that occurs spontaneously. The latter may be characterized by poor clot formation in the surgical field to extreme bleeding from previously hemostatic areas such as venipuncture sites. In many instances, the mainstay of treatment is functional and quantitative repletion of the deficient components. Even in the presence of coagulopathy, however, most bleeding complications are due to failure of local control in the operative field. Hypothermia, acidosis and shock should be identified and corrected as soon as possible. In the absence of a life threatening problem, the surgeon should terminate the operation to study, manage, and resuscitate the patient. The history can define hereditary or acquired factors. For the purpose of this discussion, preoperative work up and patient screening will be mentioned first followed by diagnosis and treatment of specific and common bleeding disorders.
KeywordsFactor VIII Disseminate Intravascular Coagulation Fresh Freeze Plasma Disseminate Intravascular Coagulation Placental Abruption
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