PO0040 - Complex Bleeding Management – Multidisciplinary Approach

Background: The mortality risk in hypocoagulation disorders is reported to be about 30-40%. Without a multidisciplinary approach, there is high risk for morbidity and mortality. With increased bleeding the patients are at risk for transfusion associated complications too. Accurate diagnosis and early intervention would reduce both morbidity and mortality. In the developing countries, availability of laboratories capable of making an accurate diagnosis, resources for identifying the source of bleeding and managing the patient comprehensively is much more challenging. Here we are presenting our data relating to such complex bleeds and a multimodality approach for control of the bleeding.

Aims: Managing complex bleeds in hypo coagulation disorders using a multidisciplinary approach will reduce both morbidity and mortality

Methods: Here we present the data from 3 patients that were admitted with major bleeding manifestations and how a multimodality approach for identification and control of the bleeding was made . Data was collected from HIMS.

Results: Amongst the cases presented, 2 had severe, Type III von Williebrand disease and 1 had Factor XIII deficiency. Presenting complaints were severe uterine bleeding in one, upper GI bleeding in one and epistaxis in another. All three cases received multiple transfusion support.
The profile of the patients is depicted in the table below

Conclusion(s): Complex bleeds in hypocoagulation are difficult to manage, which need both supportive care to maintain hemoglobin and hemodynamic stability and factor replacement, in parallel with finding the source and controlling it. Massive transfusion associated issues need to be keep in mind when managing such bleeds. Complex bleeds need multidisciplinary approach as presented above or else mortality in these patients is high.