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Dr Raj Warier, Louisiana 16 January 2018

It is important to understand the pathophysiology of coagulation.
For the correct diagnosis, accurate history of the patient should be taken; simple initial laboratory tests should be followed up with specific laboratory tests.
Fragmented red cells (schistocytes) are seen in microangiopathies (e.g., TTP, HUS, DIC), and cardiovascular disorders. Serial counting in TTP may correlate with change in serum LDH levels. Normal reference range of schistocyte count is 0.03-0.58%.
Central nervous system bleeds – These are the most common cause of fatal bleeding. They may occur in a delayed fashion. We must treat even minor head trauma in general. When in doubt, or if there is any sign of objective head trauma, we must treat.
Treatment of bleeding is based on diagnosis – avoid FFP, steroids, etc. without diagnosis except in emergency cases.
Comprehensive care should be provided.
Bleeding vs. thrombosis:

Bleeding	Thrombosis
Decreased procoagulant factors	Increased procoagulant factors; decreased natural anticoagulants
Thrombocytopenia	Thrombocytosis
Vessel wall damage	Vasculitis
Increased fibrinolytic potential	Decreased fibrinolytic potential

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