Monitoring of Hemostasis

Abstract

Critically ill patients (CIP) are patients who, because of dysfunction or failure of one or more organs/systems, depend on advanced instruments for monitoring and therapy for their survival. Coagulation abnormalities are common in CIP. The most common (35–44%) is thrombocytopenia (platelet count less than 150,000/µl), due to sepsis, disseminated intravascular coagulation (DIC), thrombotic microangiopathy, or induced by drugs, such as heparin. Prolonged global coagulation times, beyond antithrombotic therapy, are also found, and are a result of quantitative defects of coagulation factors, caused by synthesis defects (liver insufficiency), excessive loss (massive hemorrhage), or consumption (DIC), low levels of one or more coagulation factors due to antibodies, antiphospholipid antibodies, or the presence of inhibitors. This chapter provides information on the principles, clinical significance, technology, and open problems in laboratory assessment of hemostasis in critically ill patients.