Acquired Post-Surgical Coagulopathy
Postoperative bleeding may result from technical causes, coagulopathy, or both.
Any surgical procedure carries a risk of postoperative bleeding. While this complication typically can be controlled via conventional means, postoperative bleeding in the setting of specific acquired coagulopathies requires a precise understanding of the underlying pathophysiology and differential diagnosis, in order to manage the patient appropriately and improve clinical outcomes.
Acquired Etiologies
Acquired post-surgical coagulopathies are those that did not exist prior to surgery. Post-surgical coagulopathy can commonly occur in a variety of contexts, including:
Post-Surgical Iatrogenic Immune-Mediated Coagulopathy
Iatrogenic immune-mediated coagulopathy (IMC) is a less common type of acquired post-surgical coagulopathy. Iatrogenic IMC is a phenomenon in which the development of antibodies interferes with the proper functioning of the coagulation process.
Iatrogenic IMC can include acquired platelet disorders, such as heparin-induced thrombocytopenia (HIT), or acquired specific factor inhibitors, such as bovine thrombin-associated coagulopathy.
Examples
Primary immune response to antigen exposure manifests about 7-14 days following exposure, depending on the potency of the immunogen and the sensitivity of the detection methods used. Subsequent exposure results in a secondary, or anamnestic, immune response characterized by a shorter lag time and more rapid rise in antibody titers, along with a higher and longer steady-state antibody titer than that seen in the primary response (see figure above). Not all patients exposed to antigens will develop clinical symptoms.
References:
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