Rational hemostatic screening

Background: In order to exclude hemorrhagic diathesis, e. g. before diagnos tic measures carrying the risk of bleeding or in preoperative situations, a graded screening is advisable. Procedure: During the first stage, besides the anamnesis, clinical examinat ion and classification of relevant concomitant diseases (e. g. liver cirrho sis or renal insufficiency), basic laboratory examinations such as prothrom bin time, activated partial thromboplastin time (aPTT) and platelet count m ust be carried out. Should all these measures produce no noteworthy results , no further examinations are necessary. However, in the case of test resul ts within normal limits accompanied by an unsatisfactory anamnesis and/or c onspicuous clinical findings. the second stage should include examination o f bleeding time according to Mielke to exclude a relevant platelet dysfunct ion. Should this be inconspicuous a third stage should follow in which succ essive implementation is made of fibrinogen according to Clauss, the Rumpel -Leede test (to exclude heightened capillary fragility), factor XIII and al pha(2)-antiplasmin. The methodical snares of the parameters mentioned will be explained in full.