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….
Based on these results, does the patient have a coagulopathy?
The platelet count, prothrombin time (PT), and partial thromboplastin time (PTT) are all normal, ruling out thrombocytopenia or a factor deficiency, but this is not surprising given the patient's age and lack of bleeding history or liver disease. Neither cholesterol-lowering agents nor betablockers are strong inhibitors of platelet function, but daily aspirin use can significantly inhibit platelet function through its blockade of cyclooxygenase-dependent activation. Furthermore, von Wille brand disease, a common inherited platelet functional defect, must be considered in any patient with uncontrolled bleeding after trauma or with surgery. To look at these possibilities, a PFA screening test is ordered, the results of which are as follows: PFA collagen/ADP closure time = 95 seconds (80-1 20 seconds} PFA collagen/epinephrine closure time (I I 0- 1 80 seconds) 245 seconds In addition, a computed tomography (CT) scan of the head with contrast demonstrates a subdural hematoma. The neurosurgeon recommends immediate surgery, but because of the aspirin use and the PFA result, the neurosurgeon requests a consult for medical management of bleeding risk prior to the operation.
• Based on these results, does the patient have a coagulopathy?
• If so, does he require immediate treatment prior to surgery?