Objective
To investigate in‐vitro haemostasis in subjects with symptoms suggesting a mild bleeding disorder.
Design
A prospective study in which an extensive range of in‐vitro tests were applied unselectively.
Setting
Patients were referred from community‐based practices and hospital outpatient services.
Patients
Ninety‐three consecutive patients were examined. Hospital patients with severe illness were excluded.
Clinical features
Patients presented with easy bruising (68%), epistaxis (12%), excessive operative bleeding (7%), menorrhagia (4%), haematuria (3%), dental bleeding (1%) and bleeding from other sites (5%). In no instance was the bleeding life threatening.
Outcome measures
Results of laboratory tests for patients presenting with the symptoms of a mild bleeding disorder were compared with the results for a healthy reference group.
Results
Abnormal results of in‐vitro tests were found in 53% of the subjects. Thirteen per cent had a prolonged bleeding time, of whom the majority had abnormal results of other in‐vitro tests. Von Willebrand's disease was diagnosed in 7% of patients, although only half of these had a prolonged bleeding time.
Conclusions
Abnormal results of in‐vitro tests were prevalent among subjects with symptoms of mild bleeding disorder. Easy bruising was as powerful a clue as any other bleeding manifestation to the presence of an abnormal in‐vitro test result.
Stein 0, et al. Effect of Vitamin C and E supplementation on susceptibility of plasma lipoproteins to peroxidation induced by acute smoking. Atherosclerosis 1990;85:47-54. 5 Nowak D, Ruta U, Piascecka G. Nicotine increases human polymorphonuclear leukocytes chemotactic response-a possible additional mechanism of lung injury in cigarette
Heparin-induced skin necrosis is a rare but serious complication of subcutaneously administered heparin. Previous reports indicate that the skin necrosis is often accompanied by thrombocytopenia and occasionally by lethal thromboembolism. It thus shows features similar to the heparin-induced thrombocytopenia (HIT) syndrome and probably represents a localized form of this condition. Caution is required in the event of skin necrosis; heparin therapy should be ceased immediately and not used again if the complications of HIT are to be avoided.
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