Management of a 66-Year-Old Male with Resolved Bruise and Pending Lab Results
The appropriate next course of action for this 66-year-old male patient with a resolved bruise is to review the pending laboratory results (CBC, PT, liver panel, D-dimer, and PT/INR) and schedule a follow-up appointment to discuss findings and determine if further investigation is needed based on any abnormalities detected. 1
Interpretation of Pending Laboratory Tests
When the lab results become available, they should be systematically evaluated:
Complete Blood Count (CBC)
- Check for thrombocytopenia (<150,000/μL), which could indicate bleeding disorders 2
- Evaluate hemoglobin and hematocrit for signs of anemia that might suggest chronic blood loss
- Assess white blood cell count for signs of infection or inflammation
Coagulation Studies (PT, PT/INR)
- Normal PT/INR ranges typically between 11.5-14.5 seconds 1
- Prolonged PT/INR may indicate:
- Liver dysfunction
- Vitamin K deficiency
- Use of anticoagulants (particularly warfarin)
- Coagulation factor deficiencies 2
Liver Panel
- Abnormal liver function tests may suggest liver disease affecting coagulation factor production
- Correlate with PT/INR results, as liver dysfunction can cause coagulopathy 1
D-dimer
- Elevated D-dimer may indicate active clot formation/dissolution
- While sensitive, D-dimer has poor specificity and can be elevated in many conditions besides thrombosis 1, 2
Decision Algorithm Based on Lab Results
If All Results Normal:
- Reassure the patient
- Document the resolved bruise as likely due to minor trauma
- Consider routine age-appropriate health maintenance
If Abnormal Platelet Count:
- <150,000/μL: Consider further evaluation for thrombocytopenia
- <50,000/μL: More urgent evaluation needed as bleeding risk increases significantly 2
If Abnormal PT/INR:
- Mildly elevated: Consider vitamin K status and medication review
- Significantly elevated (>1.5× normal): Consider liver disease, vitamin K deficiency, or unrecognized anticoagulant use 3
If Abnormal Liver Tests:
- Correlate with PT/INR results
- Consider hepatology referral if significant abnormalities present
If Elevated D-dimer:
- Consider ultrasound screening of lower extremities to rule out deep vein thrombosis 1
- Evaluate for other causes of elevated D-dimer (inflammation, recent surgery, age)
Important Considerations
Medication Review
- Specifically inquire about use of:
- Anticoagulants (warfarin, DOACs)
- Antiplatelet agents (aspirin, clopidogrel)
- NSAIDs
- Supplements that may affect coagulation (fish oil, ginkgo, etc.) 3
Additional History Points
- History of easy bruising or prolonged bleeding
- Family history of bleeding disorders
- Recent falls or trauma that patient may not recall
- Alcohol consumption (affects liver function and platelet function)
Common Pitfalls to Avoid
Dismissing a single resolved bruise without appropriate follow-up
- Even though the bruise has resolved, underlying coagulation disorders may be present
Overinterpreting laboratory results
- Minor abnormalities may not be clinically significant
- Consider the patient's clinical presentation alongside laboratory values 4
Failing to communicate results to patients
- Studies show that 94% of patients prefer to receive notification of all test results, both normal and abnormal 5
Not considering age-related changes
- Elderly patients may have increased bruising tendency due to skin fragility and capillary weakness, even with normal coagulation
Missing medication interactions
- Some medications may interact with others to increase bleeding risk even at therapeutic doses 3
By following this structured approach to evaluating the pending laboratory results, you can ensure appropriate follow-up care for this patient with a resolved bruise and determine if further investigation or specialist referral is warranted.