[Rational hemostatic screening].

BACKGROUND: In order to exclude hemorrhagic diathesis, e.g. before diagnostic measures carrying the risk of bleeding or in preoperative situations, a graded screening is advisable. PROCEDURE: During the first stage, besides the anamnesis, clinical examination and classification of relevant concomitant diseases (e.g. liver cirrhosis or renal insufficiency), basic laboratory examinations such as prothrombin time, activated partial thromboplastin time (aPTT) and platelet count must be carried out. Should all these measures produce no noteworthy results, no further examinations are necessary. However, in the case of test results within normal limits accompanied by an unsatisfactory anamnesis and/or conspicuous clinical findings, the second stage should include examination of bleeding time according to Mielke to exclude a relevant platelet dysfunction. Should this be inconspicuous a third stage should follow in which successive implementation is made of fibrinogen according to Clauss, the Rumpel-Leede test (to exclude heightened capillary fragility), factor XIII and alpha 2-antiplasmin. The methodical snares of the parameters mentioned will be explained in full.