James talks to Dr Shafqat Inam about an approach to the management of bleeding disorders.
Summary Writer: Cynthia Yang
Editor: James Edwards
Interviewee: Shafqat Inam
Shafqat Inam is currently a Haematology Registrar at Royal Prince Alfred Hospital and Concord Hospital and Associate Lecturer at the University of Sydney. He studied medicine at the University of New South Wales and completed his junior medical officer and Basic Physician Training at Royal Prince Alfred Hospital. He has a particular interest in research and medical education.
With Dr Shafqat Inam, Haematology Registrar at Concord Hospital and Royal Prince Alfred Hospital, New South Wales, Australia
Clotting is dependent on functional platelets, coagulation factors and vasoconstriction. The cause of bleeding diathesis is usually multifactorial in hospital patients with problems with anticoagulants, anti-platelets, congenital disorders and platelet disorders most commonly seen. Patients with bleeding diathesis can present with anaemia due to slow bleeding over time, or a sudden significant bleed, such as a gastrointestinal bleed.
When interpreting coagulation studies we need to consider the clinical context. APTT measures therapeutic heparin, PT/INR reflects warfarin therapy; both are for general screens for clotting problems. Platelet count normally is around 150-400 x 10^9/L of blood, but what’s normal also depends in the context.
You are a night intern and have been asked to review a patient that has become hypotensive and tachycardic following a right total hip arthroplasty. He is also becoming anxious and pale. There is a large painful haematoma under the surgical site.
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