A 57-year-old woman, scheduled for an elective hysterectomy, is referred for management of her anticoagulation during the perioperative period.

A 57-year-old woman, scheduled for an elective hysterectomy, is referred for management of her anticoagulation during the perioperative period. She is currently receiving warfarin 3 mg daily for a 5-year history of atrial fibrillation with past evidence of a single embolic event. Other medical problems include hypertension and diabetes, controlled with an angiotensin-converting enzyme (ACE) inhibitor and diet. She also takes a baby aspirin each day. Examination reveals a healthy black female with no complaints. Positive findings on examination include an irregularly irregular heart rhythm and a faint diastolic murmur Vital signs: BP – 1 55/80 mm Hg, pulse – 75 bpm, resp – 1 6/min, T – 3rc. Coagu lation studies: Platelet count = 21 0,000/J.LL PT = 25. 1 seconds (< 14=”” seconds)=”” inr=”2.4″ (0.8-=”” 1=”” .3)=”” ptt=”29″ seconds=”” (22-35=”” seconds)=”” question=”” •=”” given=”” the=”” potential=”” for=”” significant=”” hemorrhage=”” during=”” surgery,=”” how=”” should=”” this=”” patient=”” be=””>

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Based on smear morphology and the red blood cell indices (mean cell volume [MCV], mean cell hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC]), the patient has a severe microcytic, hypochromic anemia most likely caused by iron deficiency (see Chapter 5).

Based on smear morphology and the red blood cell indices (mean cell volume [MCV], mean cell hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC]), the patient has a severe microcytic, hypochromic….

Given the diagnosis of HHT, how should this patient be managed?

The patient's history and physical examination (telangiectasia involving the lips, tongue, and palms) are consistent with a diagnosis of hereditary hemorrhagic telangiectasia (HHT). Three diagnostic criteria are met: multiple telangiectases,….

As this patient with HHT grows older, her bleeding tendency will likely become progressively more difficult to manage.

As this patient with HHT grows older, her bleeding tendency will likely become progressively more difficult to manage. If she were premenopausal, oral contraceptives would be an option, but in….