Book Review

Disorders of Hemostasis

N Engl J Med 1996; 335:1694November 28, 1996

Article

Disorders of Hemostasis
Third Edition. By Oscar D. Ratnoff and Charles D. Forbes. 563 pp. Philadelphia, W.B. Saunders, 1996. $140. ISBN: 0-7216-5273-5

It comes as no surprise that this third edition of Disorders of Hemostasis differs considerably from the second one (1991), because of the rapid progress in the field. O.D. Ratnoff, one of the nestors of hemostasis, sets the stage with a historical account of the evolution of knowledge on the subject. Ratnoff also contributes 3 other lucid chapters; the remaining 17 are written by 20 experts, 13 of them American, 5 Scottish, 1 English, and 1 Japanese — a somewhat uneven distribution of hemostasis researchers.

The chapters on normal hemostatic mechanisms and on platelets and their disorders are superb and up to date. The fine chapter on platelets is packed with valuable information. The concise chapter on the difficult problem of laboratory diagnosis of bleeding disorders is well organized and contains analytic tables based on three simple measurements: the activated partial-thromboplastin time, prothrombin time, and thrombin time. Collectively, these are of considerable help in the differential diagnosis of a hemorrhagic disorder. The next three chapters contain clear discussions of genetic disorders of hemostasis. There is considerable overlap between the chapter on disseminated intravascular coagulation and the one on fibrinolytic bleeding syndromes, but primary fibrinolysis and fibrinolysis due to hypercoagulation cannot be rigidly separated. Five comprehensive chapters deal with bleeding associated with neoplasia, infection, surgery, liver disease, and kidney disorders. Others discuss hemorrhagic disorders of neonates, psychogenic bleeding, and bleeding due to drugs, venoms, and vascular defects. The book ends with a concise discussion of the complications of treatments for bleeding disorders.

In general, all the chapters have a practical focus. Although it is richly illustrated with informative tables and graphs, the book lacks boxed paragraphs summarizing strategies and recommendations for treatment. Another drawback is that the editors failed, or did not wish, to weed out the redundancy in the various chapters. An extensive index partially compensates for the scattering of information on particular topics throughout the book. This book is about bleeding problems, but some authors include sections on thrombosis; these may disrupt the balance of the chapters, but not that of the book. The references closing each chapter are numerous, but there are relatively few citations of material published in the past three years.

Unevenness in style and presentation, inevitable in multiauthored books, is a small price to pay for the subtlety of understanding that only experts of international standing can provide. The book is beautifully presented. It is not to be read from cover to cover, but rather should be seen as a portal of entry into the field for uninitiated residents and as an updated resource for trained hematologists and internists.

Marc Verstraete, M.D., Ph.D.
University of Leuven, B-3000 Leuven, Belgium