HAEMORRHAGE NOT ASSOCIATED WITH ORAL ANTICOAGULATION OVERDOSE

Essential investigations: FBC, coagulation profile, FDPs, LFTs

Platelet transfusions: Usually platelets should be prescribed as “one unit platelets IV over 30 mins”. 

Platelet transfusion indicated when there is:

Platelet count <15x10⁹/l; no coagulopathy and patient not bleeding
Platelet count <30x10⁹/l; plus coagulopathy or patient bleeding
Platelets <50 with DIC or pre-op
If in doubt, discuss with haematologist

Fresh Frozen Plasma: contains all necessary coagulation proteins but remember half-life of Factor’s VII V and VIII is only a matter of several hours and repeated infusions of fresh frozen plasma may be necessary 12 hourly.  FFP is usually administered as a dose of 15mls/kg when there is a global coagulopathy and when bleeding where INR is >1.6.

Cryoprecipitate: rich in fibrinogen and VIII.  Given as a dose of 5-15 units particularly useful where fibrinogen levels are low (<1g/ l) or thrombin time significantly prolonged and when bleeding following FFP.  Sometimes of use in bleeding associated with azotemia.