Description
Book SynopsisA practical guide to laboratory diagnosis and treatment of hemostatic disorders.
This concise book distils the most clinically up-to-date information on thrombotic and bleeding disorders, including the latest treatment strategies, for key conditions and diseases. Essential Guide to Blood Coagulation covers both the stable and the acute stages of hereditary and acquired bleeding and thrombotic disorders.
Faced with a bleeding patient, it may be difficult to determine whether blood loss is due to a local factor, or an underlying hemostatic defect. There are a range of laboratory tests which can be performed to identify the cause of bleeding in a patient. This book highlights the tests that can be used in the laboratory to aid diagnosis.
Essential Guide to Blood Coagulation has been updated to include the new anticoagulants and now has a dedicated chapter on antiplatelet drugs. This invaluable guide will help all those treating patients to
Trade Review
“Nevertheless, this book could one day become the ‘oxford handbook’ – equivalent for coagulation.” (The Haem Trainee, 1 August2013)
“This book would be useful to those wanting an introduction to coagulation disorders. More experienced practitioners will likely find its treatment of coagulation disorders too superficial for their needs.” (Doody’s, 23 August 2013)
Table of ContentsList of contributors, x
Preface, xii
Abbreviations, xiii
PART 1: GENERAL HEMOSTASIS
1 Schematic presentation of the hemostatic system, 3
Nils Egberg
2 Proposals for sampling instructions, 6
Margareta Blombäck and Nils Egberg
Points to note prior to sampling, 6
Sampling time and patient preparation, 7
Referrals for coagulation analyses, 8
Sampling, 8
Technique, 9
For DNA investigation (genetic analyses), 10
3 Laboratory investigations, 11
Jovan P. Antovic, Liselotte Onelöv, and Nils Egberg
Nomenclature, 11
Reference intervals for laboratory investigations, 13
Screening analyses, 13
Special analyses, 20
Markers of coagulation activation (hypercoagulation markers), 29
DNA analyses, 29
Global hemostatic assays and bedside methods, 31
Useful components in research studies, 32
Platelet-activating predictors, 35
PART 2: BLEEDING DISORDERS
4 Hereditary bleeding disorders, 41
Margareta Holmström and Lars Göran Lundberg
General remarks about hemophilia A and B, 41
General remarks about von Willebrand disease, 42
Factor concentrates used for treatment of hemophilia A and B and VWD in Sweden in 2012, 43
Treatment strategy in severe forms of hemophilia and VWD, 44
Recommendations for desired initial plasma concentrations at different types of bleedings, 45
Surgery in patients with bleeding disorders, 47
Tooth extraction in a hemophilia patient, 47
Caution in patients with bleeding disorders, 48
Treatment principles for different types of bleeding disorders (severe, moderate, and milder forms of hemostatic defects), 49
Rare bleeding disorders, 51
Blood sampling in bleeding disorders, 54
Bleeding risk charts, 54
5 Critical bleeding, 56
Maria Bruzelius, Anna Ågren, and Hans Johnsson
Introduction, 56
Definition of massive bleeding, 56
Transfusion coagulopathy, 56
Recommendations to obtain optimal hemostasis, 57
Choice of plasma, 58
Local procedures, 59
Additional treatment, 59
Fibrinogen concentrate, 59
Prothrombin-complex concentrate (PCC), 59
Recombinant factor VIIa, 59
Concentrates of other coagulation factors, 60
Cryoprecipitates, 60
Tranexamic acid, 60
Desmopressin, 60
Local hemostatic drugs, 60
Complicating factors, 61
Ongoing treatment with antiplatelet, and anticoagulant drugs, 61
6 Investigation of increased bleeding tendency, 62
Margareta Holmström and Lars Göran Lundberg
Introduction, 62
Diagnosis, 62
Reasons for pathologic screening analyses and further actions, 64
Causes of thrombocytopenia, 64
Causes of prolonged activated partial thromboplastin time, 65
Causes of elevated PT(INR), 66
Investigation of bleeding tendency: practical aspects, 66
PART 3: THROMBOEMBOLIC DISORDERS
7 Venous thrombosis and pulmonary embolism, 71
Anders Carlsson
Introduction, 71
Venous thrombosis, 72
Pulmonary embolism, 75
Primary prophylaxis against VTE, 91
8 Investigations of thromboembolic tendency, 94
Margareta Holmström
Introduction, 94
Venous thromboembolism, 95
Arterial thromboembolism, 96
Disseminated intravascular coagulation, 96
9 Heart disease, 97
Håkan Wallen and Rickard Linder
Ischemic heart disease, 97
Atrial fibrillation, 102
Cardiac valve prosthesis, 103
New oral anticoagulants in the treatment of heart disease, 104
10 Antiplatelet drug therapy and reversal of its effects, 105
Håkan Wallen, Hans Johnsson, and Bo-Michael Bellander
Introduction, 105
ASA, 105
ADP (P2Y12) receptor antagonists, 106
GPIIb/IIIa receptor antagonists, 106
Phosphodiesterase inhibitors and other antiplatelet compounds, 108
Combined antithrombotic treatment, 108
Benefi t–risk assessment, 108
Platelet transfusion, 109
11 New oral anticoagulants: Focus on currently approved oral factor Xa and Thrombin inhibitors, 111
Rickard E. Malmström and Hans Johnsson
Clinical pharmacology of NOACs, 111
Possibility of and need for therapeutic monitoring of NOACs, 114
Clinical aspects of NOACs, 114
Results of clinical trials, 116
Some characteristics of the individual NOACs, 118
Considerations to be taken when using NOACs in some emergency situations
12 Stroke and transient ischemic attack, 121
Nils Wahlgren and Mia von Euler
Antithrombotic secondary stroke prevention, 121
Atrial fibrillation and TIA or stroke, 122
Thrombolysis in stroke, 122
Cerebral venous thrombosis and dissection of precerebral arteries, 123
Recurrent TIA, 124
Prophylactic treatment against DVT and PE, 124
13 Peripheral artery surgery, 125
Jesper Swedenborg
Prophylaxis against reocclusion in peripheral vascular surgery or percutaneous transluminal angioplasty (PTA), 125
Peri- and postoperative treatment, 125
Thrombolysis in acute ischemia, 126
PART 4: SPECIAL HEMOSTASIS
14 Hemostasis in obstetrics and gynecology, 129
Katarina Bremme
Introduction, 129
Thrombosis during pregnancy, 131
Heart disease: treatment of women with mechanical heart valve prostheses, 139
Thromboprophylaxis in obstetrics and gynecology, 140
Blood sampling in children of women with severe forms of thrombophilia, 148
Obstetric epidural/spinal analgesia (anesthesia), 148
Complications during pregnancy, 150
Postpartum bleeding, 155
Thromboprophylaxis in legal and spontaneous abortions, 156
Thromboprophylaxis in gynecologic surgery, 156
Investigation prior to artificial insemination (IVF), 160
Investigation in repeated miscarriages, 160
Investigation in menorrhagia (for treatment see Chapter 4), 161
15 Hemostasis in children, 162
Susanna Ranta and Pia Petrini
Introduction, 162
Bleeding disorders in children, 166
Thromboembolic disorders in children, 172
16 Emergency conditions associated with coagulation: DIC, HIT and TTP/HUS, 182
Jovan P. Antovic and Margareta Holmström
Disseminated intravascular coagulation, 182
Heparin-induced thrombocytopenia, 188
Thrombotic microangiopathies, 190
Index, 191
