Case Study#6   1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16   ER Management Initial impression: hypovolemic shock due to GU hemorrhage caused by a coagulopathy One unit of O-neg uncrossmatched packed red cells was given in the ER Repeat labs: Hct 12.3%, Plt: 227, PT and PTT still > 2 min Generic coag workup so far: Clinical evaluation - Age and family history (congenital vs. acquired) - Medications (aspirin, NSAIDs) - Bleeding pattern (mucosal vs tissue) Routine screening tests - Platelets - count and bleeding time - coagulation factors/inhibitors - PT and aPTT Breakpoint #3 How would you workup this particular coagulation disorder? Could the coagulation results represent an artifact? How would you rule out this possibility?