The Coagulation Consult: A Case-Based Guide

by Alan Lichtin (Editor), John Bartholomew (Editor)

Overview

There have been many changes in the field of coagulation during the past decade. New concepts of epidemiology of risk factors for thrombosis now help clinicians predict who is more likely to form clots after surgery, or after being placed on oral contraceptives. New anticoagulants have the potential to redefine how patients with atrial fibrillation and venous thrombosis are managed. There are new forms of recombinant clotting factors which have changed our approach to hypofibrinogenemia and von Willebrand’s disease. Newer antiplatelet agents are available and their use in patients receiving cardiac stents has mushroomed. The management of thrombosis in the setting of pregnancy has changed over the past decade, as well as the way clinicians approach women with multiple miscarriages. An entire new class of compounds, the thrombopoietins, are available to treat individuals with immune thrombocytopenic purpura (ITP).

The Coagulation Consult covers major topics of interest to hematologists who are asked to consult on individuals with coagulation related diseases, and encompasses the field’s most recent developments. This “case-directed” book describes state-of-the-art approaches to patients with bleeding and clotting disorders, as well as laboratory tests for coagulation. Chapters include different vignettes, focus on typical clinical consult questions, and lay out specific types of treatment. Practicing clinicians being confronted with coagulation consult students, residents, fellows and attending physicians will find this unique text an invaluable resource for some of the newer areas of coagulation science, therapy and pharmacology.

Product Details

ISBN-13:	9781461495604
Publisher:	Springer-Verlag New York, LLC
Publication date:	02/06/2014
Sold by:	Barnes & Noble
Format:	eBook
Pages:	279
File size:	3 MB

About the Author

Alan Lichtin, MD, Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic, Cleveland, OH, USA

John Bartholomew, MD, Department of Cardiovascular Medicine and Hematology, Cleveland Clinic, Cleveland, OH, USA

Table of Contents

​Laboratory Analysis of Coagulation.- Easy Bruisability.- Prolonged PT.- Prolonged PTT.- Prolongation of Both PT and aPTT.- Excessive Bleeding with Normal Prothrombin Time, Partial Thromboplastin Time, and Platelet Count.- Diagnosing Thrombocytopenia in the Clinic.- Thrombocytopenia in the Intensive Care Unit and after Solid Organ Transplantation.- Thrombocytosis.- Prolonged Bleeding after Surgery.- The Excessively Clotting Cancer Patient.- Thrombotic Risk factors.- Clotting around Catheters and Other Devices.- Heparin-Induced Thrombocytopenia.- Surgery on Patients on Antiplatelet Agents.- Newer Oral Anticoagulants.- Pregnancy.

Editorial Reviews

From the reviews:

“The purpose is to address and bridge the gap in commonly encountered coagulation issues, today curiously artificially separated and managed by either vascular surgeons (thrombotic disorders) or clinical hematologists (bleeding disorders). … It also would be useful to anyone in training or in practice in any medical specialty involved in the long-term management of patients with these conditions. … a practical and very useful guide for clinical coagulation consultation, and a must if this is part of your clinical responsibilities.” (Valerie L. Ng, Doody’s Book Reviews, May, 2014)

From the Publisher

Reviewer: Valerie L Ng, PhD MD(Alameda County Medical Center/Highland Hospital)
Description: This compilation of commonly encountered coagulation consultation scenarios completely reflects its title.
Purpose: The purpose is to address and bridge the gap in commonly encountered coagulation issues, today curiously artificially separated and managed by either vascular surgeons (thrombotic disorders) or clinical hematologists (bleeding disorders). These very worthy objectives are well met.
Audience: This book was intended for the "practicing hematologist or vascular medicine expert (either vascular medicine doctor or vascular surgeon) consulted for bleeding or clotting issues." It also would be useful to anyone in training or in practice in any medical specialty involved in the long-term management of patients with these conditions. It would be of great interest to laboratory medicine or pathology practitioners to gain insight into how laboratory results are used to guide treatment. Finally, it would be most useful to residents in virtually any specialty to gain a better perspective on how to manage these seemingly all too common complications.
Features: For the average laboratory medicine practitioner, this book is a refreshing change from the typical clotting reference. Aside from the first chapter, on laboratory analysis of coagulation, the remaining chapters are titled exactly as a clinical consult would be. The first few are common questions, e.g., "prolonged PT," "prolonged PTT," "prolongation of both PT and PTT," "excessive bleeding with normal PT, PTT and platelet count." etc. The next are common clinical scenarios, e.g., "prolonged bleeding after surgery." "the excessively clotting cancer patient," "clotting around catheters and devices," etc. Each chapter is concise and clear, with valuable concrete recommendations. Each chapter has extraordinarily useful clinical vignettes faithful to real-world clinical coagulation practice. I especially appreciated the chapter on "Thrombocytopenia in the Intensive Care Unit and After Solid Organ Transplantation." While my organization does not manage transplantation, I do spend a lot of time consulting on thrombocytopenia in the ICU. Now I'll just simply have the requesters read this illuminating chapter. Some of the clinical disorders were not where I expected to find them, however. For example, DIC and the thrombotic microangiopathies are discussed in the chapter on diagnosing thrombocytopenia in the clinic. This may simply reflect my bias toward hospital-based practice, in which these types of consultations arise from the emergency room, ICU, or inpatient medical service, but never from the clinic. Not to worry, the index is very helpful in finding topics. The chapter on "easy bruisability" has an extraordinary compilation of clinical photographs exemplary for the various conditions it discusses. One small point of confusion is in the clinical vignette in the pregnancy chapter, which states the mother is HPA-1b homozygous, yet the accompanying table lists her as HPA 1b/1a, implying a heterozygous state. Maybe I'm just confused, or maybe this was a typographical error.
Assessment: This is a practical and very useful guide for clinical coagulation consultation, and a must if this is part of your clinical responsibilities.

Doody's Review Service