Diagnosis of coagulation disorders: prediction and management of perioperative and postoperative bleeding

Plasmatic screening tests are of limited value to discover suspected dysfun ction in the highly complex interaction between cells and plasma factors in volved in hemostasis. It is of great importance to supplement laboratory re sults with acute clinical findings and information from the patient's medic al history. For assessment of primary hemostasis in vivo bleeding time has to be performed as standardized as possible. Whole-blood methods might be helpful in emergency situations due to the rap id and simple measurement procedure. These methods allow in particular the monitoring of specific hemotherapy with plasma factors or cellular blood co mponents. For the future the concept of a global test ist unrealistic: because of the complex demands such a test,would have to fulfil for screening, specific a ssessment, monitoring of therapy and hemostatic management in intensive car e units. The use of specified methods optimized for singular specific deman ds might enable a more subtle assessment of the individual patient. Further more practical approaches of monitoring should be evaluated for the many cu rrently available options of drug interventions having an effect on the hem ostatic system, particularly in view of the need of monitoring patients bei ng at risk of bleeding. In conclusion for prediction of bleeding or thrombo sis risks the family history, the patients history, age, current complaints and problems, as well as cofactors possibly enhancing morbidity mill need to be inquired and thoroughly analyzed in context with laboratory parameter s.