The use of thrombelastography to determine coagulation status in severe anorexia nervosa: a case series.

OBJECTIVE: Hospitalized patients with severe anorexia nervosa (AN) frequently have a complex coagulation profile, with elements of hypocoagulability--thrombocytopenia and elevated international normalized ratio (INR) and elements of hypercoagulability--usually manifested as immobility, which is either due to their marked weakness or from enforced degrees of bed rest to minimize energy expenditure. Hospitalized medical patients have been shown to have appropriate prophylaxis for venous thromboembolic (VTE) disease in only 40% of cases. METHOD: A simple test that could evaluate the overall coagulation profile of these patients would help guide appropriate VTE prophylaxis. The thrombelastogram is a blood test that evaluates the full dynamic process of hemostasis. RESULTS: The study of patients did not reveal evidence of being hypocoagulable and thus should be considered for VTE prophylaxis. DISCUSSION: We report on three cases of young women with severe AN and weakness, hospitalized for closely monitored refeeding, in whom the thromboelastogram was used to evaluate the coagulation status of the patient and assist in guiding therapy.