The Clinical Problem Solvers

Episode 415 – Spaced Learning Series – Beyond The Coagulation Cascade

16 snips
Aug 27, 2025
Dive into the world of coagulation as the hosts tackle a complex case of a 70-year-old man facing unusual bleeding. They dissect the nuances of hemostasis, addressing the key roles of blood components and the implications of coagulopathy. Lab findings related to leukocytosis and kidney issues are explored, emphasizing accurate diagnoses. The challenges of amyloidosis and vascular health are discussed, shedding light on the intricate relationship between conditions and bleeding risks. An interdisciplinary approach to treatment highlights the complexities of managing such cases.
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ANECDOTE

Case Kickoff: Elderly Patient With Ongoing Bleeds

  • Mukund presents a 70-year-old man with persistent oozing chest wound and retroperitoneal hematoma requiring IR.
  • This short vignette launches a layered diagnostic hunt across hemostatic systems.
INSIGHT

AL Amyloid Links Kidney, Liver, And Bleeding

  • Monoclonal light chains and AL amyloidosis can cause hypoalbuminemia, proteinuria, and bleeding.
  • AL amyloid often inactivates factor X and causes vascular fragility contributing to deep bleeds.
ADVICE

Order An Extended Coagulation Panel

  • If bleeding persists with normal PT/PTT order extended panel: TT, reptilase, factor XIII, platelet function.
  • Also review drugs and herbal supplements that could cause qualitative defects.
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