ABSTRACT
This chapter aims to provide the physiological and practical knowledge to manage three main scenarios to come across disorders of haemostasis together with surgeons' haematology team. The three scenarios are: peri-operative severe and potentially life-threatening bleeding; pre-operative assessment that identifies or suggests a patient may be at increased risk of bleeding; and post-operative thrombosis. The chapter focuses on the haematological abnormalities that lead to clots rather than the acquired non-haematological ones, of which there is a long list. There is widespread over-activation of the coagulation system leading to significant, usually arterial, thrombosis. The extensive formation of tiny blood clots throughout the body can lead to consumption of coagulation factors. These deficiencies can then lead to bleeding. In many settings there is now increasing use of thromboelastography (TEG) and rotational thromboelastography (ROTEM). This technology produces a trace providing information of time to formation of clot, and its stability, enabling a more 'real time' guide to product use.
