From time to time the surgeon is faced with the problem of an apparent defect of hemostatic function in a patient during surgery or postoperatively. This usually requires prompt and rational management, if undesirable complications are to be avoided.
Although this paper deals primarily with operative and postoperative management of unexpected defective hemostasis, it is appropriate to mention first the preoperative screening of patients for bleeding tendency, since this is by far the most important approach to the problem. It should go without saying that surgery should never be undertaken lightly in patients with a known or suspected true defect of coagulation, no matter how mild the defect is supposed to be. Elective operation on the so-called mild hemophiliac, without proper preparation, can especially give cause for regret, since the postoperative management of these patients is always complicated and costly.A brief but appropriate history is the easiest
Wilson WB. Emergency Management of Unexpected Defects of Hemostatic Function in Surgical Patients. JAMA. 1967;201(2):123-126. doi:10.1001/jama.1967.03130020069017