On a day-to-day basis, transfusion medicine practitioners are asked to play critical roles in consulting on hemostasis issues. The complexity of coagulation assays and the ever-growing numbers of laboratory tools available for managing bleeding disorders represent significant challenges for the consultant blood banker. Therefore, in order to provide the most accurate hemostasis consultation, transfusion medicine practitioners must have an up-to-date understanding of modern coagulation assays (including point-of-care testing) and how results inform transfusion management. The goal of this session is to summarize common, yet complex, hemostasis consultations faced by blood bankers and recommend detailed approaches to test interpretation and patient management. We will focus on three important areas: 1) familiarize practitioners with the concepts of point-of-care coagulation testing and demonstrate how these modalities may be used (and misused!) in managing complex bleeding disorders for critical care patients, 2) review available ‘point of care’ and more rapid platelet function assays, including strengths and limitations of such testing, and how results of these assays can be utilized in transfusion management, and 3) discuss the complex entity of major obstetric hemorrhage, including exploring its pathophysiology, review of assays which may be helpful in its assessment, and recommending practical strategies for its management.
Review with participants the various forms coagulation factor-based point-of-care testing and how these assays can be used (and misused) for management of critical care patient transfusion needs.
Examine the strengths/limitations of platelet function assays with a particular focus on point-of-care and rapid assessment modalities to discover how these tests can be used for managing the bleeding patient.
Discuss the pathophysiology of major obstetric hemorrhage, including an examination of testing modalities which may be helpful in evaluating this disorder, as well as identifying practical management strategies which stem from testing performed.
Professor of Laboratory Medicine, Director, Transfusion Medicine Fellowship,
Yale University; VA Connecticut Healthcare
Medical Director, Coagulation Laboratory, Attending, Transfusion Medicine/Apheresis Service,
University of Chicago