30.1. A 62 year old lady has very significant bleeding following an uncomplicated total hip replacement. Her coagulation profile post blood transfusion is as follows:
- (a) List two (2) likely causes of her deranged coagulation profile.
- (b) List two (2) additional pieces of information from her history which might be of importance.
- (c) Name two (2) further tests you will undertake to elucidate the cause of her coagulopathy and bleeding tendency.
30.2. List five (5) likely causes for the following coagulation profile:
30.3. A 78 year old man presented after a fall resulting in a bruised hip. His Full blood count is the following:
- (a) List four (4) causes for the raised MCV
Answer and interpretation
30.1. (a) List two (2) likely causes of her deranged coagulation profile.
- Factor 8 deficiency
- Factor 9 deficiency
- Dilutional coagulopathy
30.1. (b) List two (2) additional pieces of information from her history which might be of importance.
- Patient – past history of bleeding
- Family history of bleeding
- History of anti-platelet drugs
30.1. (c) Name two (2) further tests you will undertake to elucidate the cause of her coagulopathy and bleeding tendency.
- Factor assay.
- A Von Willebrands Disease screen.
30.2. List five (5) likely causes for the coagulation profile.
- Primary fibrinolysis
- Dilutional coagulopathy from massive transfusion
- Post thrombolysis
- Snake bite
30.3. (a) List four (4) causes for the raised MCV.
- B12 deficiency
- Folate deficiency
- Myelodysplastic syndrome
- Therapy with cytotoxics or immunosuppressants
Alcohol and hypothyroidism do not produce such high levels of MCV usually, but if mentioned answers accepted.
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.