On a day-to-day basis, transfusion medicine and apheresis practitioners are asked to play critical and often acute care roles as consultants for complex issues related to hemostasis and thrombosis. The intricacy of coagulation assays and the blood bank and pharmaceutical tools available for managing bleeding disorders have all expanded dramatically over the past 5-10 years. Therefore, in order to provide accurate hemostasis/thrombosis consultation, providers must have an up-to-date understanding of common coagulation assays and how their results inform transfusion and apheresis management. The aim of this session is to familiarize practitioners with common coagulation problems, with an emphasis on test interpretation to improve consultation and management of bleeding/clotting disorders from the transfusion medicine and apheresis perspectives. We will focus on three critical areas of hemostasis/thrombosis and intend to: 1) familiarize practitioners with the current concepts of congenital bleeding disorders, with a particular emphasis on diseases that are primarily managed via blood components (e.g., Factor V deficiency, FXI deficiency) and inform learners on how coagulation assays can be used to guide therapy for these disorders, 2) discuss the clinical problem of lupus anticoagulants (LACs), with an emphasis on demystifying the highly complicated testing platforms associated with these disorders and to highlight roles blood bank and apheresis services play in managing complications of LACs, and 3) examine the problem of cardiac surgery-associated bleeding, including exploring its pathophysiology, investigating acute care assays which may be helpful in its assessment, and recommending practical transfusion strategies for acquired platelet function abnormalities.
Distinguish congenital bleeding disorders that are managed primarily with blood bank-derived components, including test interpretation and associated transfusion strategies
Discuss the clinical problem of lupus anticoagulants (LACs), including pearls and pitfalls in test interpretation and blood bank/apheresis management of hemostasis disorders associated with LACs
Describe the problems of cardiac surgery-associated bleeding, including review of acute care testing modalities for the hemorrhaging patient and transfusion approaches to reversal of thrombocytopathy
Professor of Laboratory Medicine, Director, Transfusion Medicine Fellowship,
Yale University School of Medicine