From the Guidelines
For patients with suspected hematomatosis, laboratory tests should include early and repeated monitoring of haemostasis, using either traditional laboratory determinations such as prothrombin time (PT)/international normalised ratio (INR), Clauss fibrinogen level, and platelet count, or point-of-care (POC) PT/INR and/or a viscoelastic method. When evaluating lab results for hematomatosis, it is essential to consider the most recent guidelines, such as those outlined in the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1. Key laboratory tests for hematomatosis include:
- Prothrombin time (PT)/international normalised ratio (INR) to assess coagulation
- Clauss fibrinogen level to evaluate fibrinogen concentration
- Platelet count to assess platelet levels
- Point-of-care (POC) PT/INR for rapid assessment of coagulation
- Viscoelastic methods to evaluate the viscoelastic properties of blood These tests can help healthcare providers diagnose and manage hematomatosis, and prevent complications such as bleeding and coagulopathy. According to the European guideline, early and repeated monitoring of haemostasis is recommended, using either traditional laboratory determinations or point-of-care tests 1. Healthcare providers should interpret these laboratory results in the context of the patient's clinical presentation and medical history, and use them to guide treatment decisions, such as the administration of blood products or coagulation factor concentrates.
From the Research
Lab Results for Hematomatosis
- The coagulation screening tests that are commonly used to investigate hemostasis include prothrombin time, activated partial thromboplastin time, thrombin clotting time, fibrinogen concentration, and platelet count 2.
- These tests can help identify abnormalities in primary hemostasis, such as bleeding time or platelet function analyzer (PFA-100) 2.
- The results of these tests can be used to guide further investigation, including specific factor assays or other tests, to determine the underlying cause of hematomatosis 2.
- A study found that coagulation defects were uncommon among subjects referred for bleeding disorder assessment, and that the activated partial thromboplastin time (APTT) and thrombin time (TT) detected many nonsignificant abnormalities 3.
- The same study found that panels comprising PT/INR, APTT, fibrinogen, and TT had lower sensitivity to bleeding disorders (3.7%) than panels expanded to include von Willebrand disease (VWD) screens (8.5%), or VWD screens and light transmission platelet aggregometry (LTA) (30%) 3.
- Another study found that isolated prolongation of prothrombin time (PT) is extremely rarely clinically significant, and that there is no correlation with degree of prolongation and factor VII deficiency 4.
- The study also found that one-third of cases of isolated prolonged activated partial thromboplastin time (APTT) were clinically insignificant, while in the rest, a factor deficiency which may be deemed as a potential risk for bleeding was noted 4.
Interpretation of Lab Results
- The interpretation of lab results for hematomatosis requires careful consideration of the underlying cause of the condition, as well as the results of the coagulation screening tests 2, 3, 4.
- A multidisciplinary approach to the management of massive haemorrhage, including the use of blood products and hemostatic components, may be necessary in some cases 5.
- The use of medications, such as antithrombotic and cardiovascular agents, may also be associated with a reduced risk of bleeding in certain patients 6.
Factors Influencing Bleeding Risk
- The volume of the cerebral cavernous malformation (CCM) is a significant predictor of bleeding risk, with lesions ≥ 300 mm3 being more likely to bleed 6.
- Antithrombotic agents and propranolol may have a protective role against bleeding events in patients with CCMs 6.
- A high HAS-BLED score is not associated with an increased bleeding risk in patients with CCMs 6.