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haemorrhage
The following articles have the tag haemorrhage
Bleeding disorders may be missed in women with menorrhagia
GREATER emphasis should be given to the diagnosis of bleeding diatheses among women presenting with menorrhagia, experts warn. A panel of obstetric, gynaecology and haematology specialists recently issued a consensus statement on diagnosis and management of bleeding disorders in women. They warned von Willebrand disease and other disorders were underdiagnosed, leading to suboptimal management of bleeding events such as postpartum haemorrhage. Royal Australian and New Zealand College of Obstetricians and Gynaecologists president Dr Ted Weaver said a heavy menstrual flow early in menarche should be a warning sign. “Around 25% of von Willebrand disease in women ...
Risks with warfarin greater in renal disease
WARFARIN may need to be initiated at lower doses in patients with moderate to severe chronic kidney disease (CKD) in order to reduce their risk of haemorrhage. A US study of 578 patients found those with severe CKD (eGFR of <30 ml/min per 1.73 kg/m 2 ) had more than double the risk of major haemorrhage when taking warfarin than did those with mild or no kidney dysfunction. Patients with moderate CKD (eGFR 30-59 ml/min per 1.73 kg/m 2 ) had a 30% increased risk of major haemorrhage. As 40% of those in the study had severe or ...
Pseudoaneurysm
A lesion appears after trauma from a palm-tree splinter. A 47-YEAR-OLD woman presented with an asymptomatic nodule on her left wrist. The lesion had appeared shortly after a palm-tree splinter pierced her wrist. She had not observed any discharge from the lesion and did not complain of feeling cold, pallor or paraesthesia of the left hand. Skin coloured nodule without punctum on the wrist. Physical examination revealed a translucent, firm, non-pulsating subcutaneous nodule at the radial volar aspect of the left wrist. Ultrasound scanning demonstrated a pseudoaneurysm of the ...
Management of elevated INR
Q: An 82-year-old male patient on warfarin for atrial fibrillation has a routine INR performed and the result is 6.9 (therapeutic range 2.0-3.0). How should this patient be managed immediately and what would be the appropriate time interval for further INR testing? A: The major determinant for significant haemorrhage on warfarin is the international normalised ratio (INR) level with the risk substantially increasing when the level is >4. The initial management for the high INR involves three steps: 1. Establish the reason why the INR is elevated ...