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A surgeon recently consulted a hematologist about a patient with recurrent postoperative bleeding. Ten days previously, the patient had undergone a thoracotomy and subsequently bled from her incision on days 3 and 6. The surgeon had measured the platelet count, prothrombin time, and fibrinogen on each occasion and found no abnormality. On day 8 the patient bled again, but the laboratory studies were not repeated because two sets of values had recently been normal. When bleeding continued, the consultant was called. He noted that the patient was now bleeding not only from the incision, but also from her gingivae, from a recent venipuncture site, and into the skin. She also had guaiac-positive stools. The consultant urged a reexamination of the clotting tests. All three tests were then indeed abnormal and further studies led to a diagnosis of disseminated intravascular coagulation. This illustrates two often neglected rules: (1) bleeding from multiple
Levine PH. Emergency Search for a Bleeding Diathesis: The Internist as a Coagulation Consultant. Arch Intern Med. 1972;130(3):445–446. doi:10.1001/archinte.1972.03650030117025
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