Anyone have good ideas for a good coagulation reference for those in practice? I have been unsuccessful at finding a good reference for dealing with fairly common coag problems (mixing studies, interpreting factor deficiencies, when to recommend certain things, etc). Specifically, algorithms would be nice. Most literature and review material I have found is very non-specific, alternating between too little detail to be practical and too much detail to be practical.
coag
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Algorthimic Approach to Hemostasis Testing
It's the best one I've seen.
It's the best one I've seen.
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Did you have coag training as a resident? Is anyone in your group comfortable with coag, do you have a Hematopathologist? This is all pretty basic stuff, but I think you can get in over your head without significant experience as a consultant (IMO complex coag problems are not well managed by an algorithmic approach)
I probably did have more coag training than many residents, but still didn't feel that adequate. I understand theory well, and I know the cascade and all that, it's more just putting it into practice because so much of practical coag seems to be feel and experience. Like when to tell if an abnormality is really significant.
I agree totally it is basic stuff, but it is not obvious basic stuff. Coag sounds easy unless you actually have to deal with problems that the lab gives you. We have a couple of paths here who are very good at it, but I don't want to always have to ask them everything. And FYI having hemepath fellowship training doesn't necessarily mean you know anything about coag. Some fellowships basically ignore it from what I can gather.
I have seen that book listed, it is pretty good. But I do agree that the algorithmic approach breaks down quite frequently as a means for dealing with clinical problems.
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Coag is annoying. If you do a lot of it, you get reasonably comfortable with it. If you don't do any of it or your only exposure is peripheral, then it's easy and not hard to deal with. It's when you get occasional issues to deal with (none of which are ever straightforward) that's the problem. I haven't found a great resource either - the book listed above is good. The Kjeldsberg book has some helpful chapters too.
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Kjelsberg (sp?) is a pretty good one that we use for our coag rotation. I remember it having some good flow diagrams.
