Bhat Rahul, Cabey Whitney
Department of Emergency Medicine, Georgetown University Hospital/Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA.
Department of Emergency Medicine, Georgetown University Hospital/Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA.
Hematol Oncol Clin North Am. 2017 Dec;31(6):1105-1122. doi: 10.1016/j.hoc.2017.08.011.
Patients presenting to the emergency department with acute bleeding and a history of clotting or platelet disorder present a unique challenge to the emergency physician. The severity of bleeding presentation is based on mechanism as well as factor levels: patients with factor levels greater than 5% can respond to most minor hemostatic challenges, whereas those with factor levels less than 1% bleed with minor trauma or even spontaneously. Treatment should be initiated in consultation with the patient's hematologist using medications and specific factor replacement, except in rare, life-threatening, resource-poor situations, when cryoprecipitate or activated prothrombin complex may be considerations.
因急性出血就诊于急诊科且有凝血或血小板疾病史的患者给急诊医生带来了独特的挑战。出血表现的严重程度基于机制以及凝血因子水平：凝血因子水平大于5%的患者能够应对大多数轻微的止血挑战，而凝血因子水平低于1%的患者在受到轻微创伤时甚至会自发出血。应在与患者的血液科医生协商后开始治疗，使用药物和特定的凝血因子替代物，除非在罕见的、危及生命的、资源匮乏的情况下，此时可考虑使用冷沉淀或活化凝血酶原复合物。
