Coagulation studies can sometimes be hard to interpret, so here are a few tips 👇 First (and perhaps most important!) tip – does your patient REALLY need a coag screen? Remember, they are not a “screen” for abnormal bleeding and are meaningless without a positive bleeding history!

1. An isolated prolonged APTT is less common than an isolated prolonged PT, and often requires further investigation... 🔎 2. As with any test - if unexpected/unexplained, repeat in the first instance! Spurious results are frequently seen with coagulation testing

Bone marrow biopsy (BMB) FAQs! Ever wondered what it's all about? Keep reading... 👀 What makes up a BMB? Usually it includes 2 samples - the aspirate (liquid marrow 🩸) and the trephine (bone core 🦴)

1/ Prolonged APTT tweetorial

Quick tip; A prolonged APTT is more likely to indicate an underlying factor deficiency than a prolonged PT
BUT factor deficiency is not the most common cause for a prolonged APTT 2/ The most common causes include

- Heparin (either circulating in blood or in the line the sample was taken from)
- Lupus anticoagulant
- Liver disease (expect prolonged PT also)
- DIC (expect prolonged PT and low fibrinogen also)
- Factor deficiencies

1/ When transfusing platelets, the mantra of;

'Why use two when one will do?'

Is supported by data from the PLADO study + others (see refs) which show that giving more than a standard dose of platelets (1 pool/unit* in an adult) did not ⬇️ bleeding incidence 2/ Each platelet exposure has (uncommon but significant) risks of allergic reaction, virus transmission and...

Each exposure to platelets is also another potential exposure to HLA antigens which the recipient does not have

1/ Neutropenic sepsis tweetorial
 
Febrile neutropenia is a common and serious complication of chemotherapy treatment and can rapidly progress to life-threatening severe sepsis. Patients with bone marrow failure conditions (e.g. AML, Myelodysplastic syndrome) are also at risk. 2/ Outcomes have improved with increased recognition of the importance of prompt treatment and better supportive care, driven by initiatives such as the Surviving Sepsis Campaign.

🔥IV antibiotics must be given within one hour in all suspected neutropenic sepsis 🔥

1/ Tweetorial: DOACs in cancer
 
The risk of venous thromboembolism (VTE) is up to 7 x higher in patients with cancer, and contributes to morbidity and mortality

Overall prognosis is worse in patients with cancer and VTE, compared to those with cancer and no VTE 2/ The treatment of VTE in cancer is complex due to concerns around;

-Interactions with anti-cancer treatment 💊
-Timing of surgery and procedures 🪚 (no scalpel emoji)
-Low platelet counts due to treatment 🩸
-Higher risk of bleeding related to some cancers 🩹

1/ Antidote news! There has been promise recently regarding antidotes being developed for DOACs. Before we get onto that, a quick summary of what we have so far... 2/ In the case of bleeding while on warfarin, this should be stratified by severity. Usual rule is if life/limb/sight threatening bleeding, prothrombin complex concentrate + vit K is used. If not, vitamin K +- pause/cessation of warfarin is advised.

1/19. When considering whether a patient is at risk of bleeding before a procedure/surgery or if a patient is bleeding and you want to assess if there are any 'correctable' clotting abnormalities, a thorough approach is needed to ensure all factors are identified. 2/19. The patient might have a PT of 19 seconds but this will probably make little/no difference in terms of bleeding risk, but the clopidogrel they have continued to take without telling the nurses/medical staff really will. I.e the coagulation screen isn't the whole picture..

1/7. Prothrombin time (PT) measures the extrinsic coagulation cascade. The only 'major' clotting factor in the extrinsic pathway is factor VII. This is the clotting factor with the shortest half life, and explains why the PT is so often prolonged in unwell patients 2/7. It also makes a long PT relatively easy to investigate and manage. The absolute majority of patients with a long PT will either be vitamin K deficient, have factor VII deficiency due to consumption in sepsis/bleeding or liver disease.