Deviation in the Standard of Medical Care When Treating Coagulopathy (Clotting Disorder, Bleeding Disorder)

Evaluate breaches in the standard of care when analyzing a Deviation in the Standard of Medical Care When Treating Coagulopathy (Clotting Disorder, Bleeding Disorder)

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Prolonged bleeding
    Nosebleeds
    Bleeding gums
    Weakness
    Syncope
    Heavy mensus
    None of the above
    Why is this important?
    Patients suffering from coagulopathy typically present with a cluster of symptoms.
    (2009) 36 EOGCNA 1 153-162

  • Was a physical examination performed on the patient? Why is this important?
    Answer this question
    
A thorough physical examination must be guided by the patient's history and may include the following; a dermatologic assessment for petechiae and ecchymoses, physical signs of anemia, a joint hypermobility assessment, an assessment for cardiac murmurs, lymphadenopathy, splenomegaly, hepatomegaly, thyroid goiter, and physical evidence of cirrhosis.

    (2012) 26 EHOCNA 2 321-344 



  • Were laboratory studies performed? Why is this important?
    Answer this question
    
The laboratory evaluation of a patient with bleeding symptoms involves several screening tests that direct subsequent investigations.

    (2012) 26 EHOCNA 2 321-344 



  • Was blood dyscrasia suspected as the result of the laboratory studies? Why is this important?
    Answer this question
    
Any abnormal result warrants further investigation.

    (2012) 26 EHOCNA 2 321 



  • Was the patient referred to a hematologist? Why is this important?
    Answer this question
    
A patient who is suspected of having a bleeding disorder needs to be referred to a hematologist for a comprehensive hematological evaluation.

    (2009) 36 EOGCNA 1 153-162 



  • Which of the following advanced investigations were performed ? (Choose all that apply) Why is this important?
    Answer this question
    
If no abnormality has been discovered after the initial battery of laboratory studies, testing of factor assays, fibrinolysis, and thrombin generation completes the available diagnostic workup.

    (2005) 16 ECANCC 3 151-161 



  • Based on the studies, what was the initial diagnosis? Why is this important?
    Answer this question
    
The management of a patient with a bleeding disorder depends on the specific underlying diagnosis.

    (2006) 24 EANESC 3 549-578 



  • Did the clinician initiate treatment for Von Willebrand disease? Why is this important?
    Answer this question
    
Von Willebrand disease, which is caused by deficient or defective plasma Von Willebrand Factor (VWF), is the most common inherited bleeding disorder, affecting as much as 0.1% to 1% of the population.

    (2012) 26 EHOCNA 2 321-344 



  • Was treatment implemented for the patient with bleeding of an unknown origin? Why is this important?
    Answer this question
    
Approximately 60% of patients have bleeding disorders of unknown causes despite extensive laboratory testing. Clinically, these patients are indistinguishable from patients with known bleeding disorders and experience the same level of morbidity secondary to bleeding symptoms. Tranexamic acid and DDAVP may be useful in treating bleeding symptoms in this population.

    (2012) 26 EHOCNA 2 231-252 



  • Were discharge instructions provided? Why is this important?
    Answer this question
    
Once a bleeding disorder has been confirmed, health education is essential.

    (2012) 26 EHOCNA 2 321-344 



  • Did the clinician advise periodic follow-up of the patient? Why is this important?
    Answer this question
    
Periodic monitoring and follow-up of the efficacy of either the replacement therapy or treatment is an essential component in the management of coagulopathies.

    (2005) 19 EBLREV 2 111-123 



  • Did the clinician diagnose a clotting factor defect? Why is this important?
    Answer this question
    
Identification of the correct factor deficiency will enable the correct treatment to be administered.

    (2012) 26 EHOCNA 2 321-344 



  • Was the patient diagnosed with a platelet disorder? Why is this important?
    Answer this question
    
For initiation of the necessary treatment regime, it is vital for the accurate diagnosis to be made.

    (2012) 26 EHOCNA 2 321-344 



  • Was the underlying cause of the thrombocytopenia identified? Why is this important?
    Answer this question
    
Thrombocytopenia, usually defined as a platelet count of less than 150,000/μL, is a common reason for a hematology consult. In most patients, the cause of the thrombocytopenia can be identified and treated.

    (2012) 26 EHOCNA 2 231-252 



  • Was the underlying cause of the acquired bleeding disorder diagnosed? Why is this important?
    Answer this question
    
In contrast to the inherited deficiencies, coagulation factor deficiencies are commonly acquired.

    (2009) 29 ECLLMD 2 229-252 



  • Which of the following components were administered? Why is this important?
    Answer this question
    
A variety of synthetic products are available as a replacement for the missing or ineffective coagulation factors.

    (2012) 26 EHOCNA 2 321-344 



  • What treatment was initiated? Why is this important?
    Answer this question
    
DDAVP, rFVIIa, and anti-fibrinolytic agents (tranexamic acid and epsilon-aminocaproic acid) have all been used in the treatment of inherited platelet disorders.

    (2006) 24 EANESC 3 549-578 



  • Was treatment initiated for the thrombocytopenia? Why is this important?
    Answer this question
    
Treatment of thrombocytopenia varies according to the underlying condition causing the thrombocytopenia.

    (2012) 26 EHOCNA 2 231-252 



  • Was treatment initiated for the acquired bleeding disorder? Why is this important?
    Answer this question
    
Treatment modalities are contingent upon the underlying causative disorder.

    (2009) 29 ECLLMD 2 229-252