Why Is The Old Lady Nose-Bleeding Post Successful Operation?

Case synopsis An 85-year-old woman suffered a fall and fractured her left neck of the femur. She was admitted to the orthopedic ward and underwent a successful operation. Since her medical history included hypertension and chronic renal impairment, her team were aware that low-molecular-weight heparin (LMWH, e.g.

enoxaparin) should be avoided; hence heparin was used postoperatively to prevent thrombus formation. Four days later the patient is complaining of a nosebleed that does not seem to be stopping. Investigations Blood count at admission: WBCs: 9.9 (Normal range: 4-11 × 10 9 /L) Hb: 12.8 (Normal range: 13-18 g/dL) Platelets: 350 (Normal range: 150-400 × 10 9 /L) Repeat count after the nosebleed: WBCs: 10.2 (Normal range: 4-11 × 10 9 /L) Hb: 11.8 (Normal range: 13-18 g/dL) Platelets: 90 (Normal range: 150-400 × 10 9 /L) *This case is from Docplexus editorial team for educative…