Investigations

The initial choice of investigations depends upon the bleeding pattern. If coagulation defect suspected:

• activated partial thromboplastin time (APTT)

If platelet pathology suspected:

• platelet count

• skin bleeding time (of doubtful value)

The full blood examination and blood film is useful in pinpointing the aetiology. Platelet morphology gives a diagnostic guide to inherited platelet disorders. The skin-bleeding time as a screening test of haemostasis has been shown recently to be severely limited by its lack of specificity and sensitivity and its routine use cannot be recommended. It is not a useful predictor of surgical risk of haemorrhage. 1 2 Other sophisticated tests can be advised by the consulting haematologist. One of considerable value is the bone marrow examination, which is useful to exclude the secondary causes of thrombocytopenia such as leukaemia, other marrow infiltrations and aplastic anaemia. A summary of appropriate tests is presented in Table 35.4 and of blood changes for some coagulation factor deficiencies in Table 35.5.

Table 35.4 Laboratory investigation checklist for the easy bruiser

• Full blood count

• Platelet count

• Prothrombin time

• Activated partial thromboplastin time

Table 35.5 Blood changes for specific coagulation factor disorders

Haemophilia A von Willebrand's disease Vitamin K deficiency

PT Normal Normal T

APTT T T T

Bleeding time Normal T Normal

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