Overview of laboratory diagnostics for immediate management of patients presenting to the emergency department with acute bleeding

Acute, life-threatening bleeding is a relatively common but critical presentation in the emergency department (ED), needing immediate assessment and intervention to reduce morbidity and mortality. Rapid identification of the bleeding source, evaluation of hemostatic function, and timely initiation of resuscitation are essential components of early management. Laboratory diagnostics plays a central role in this process, enabling clinicians to stratify the risk, guide therapeutic decisions, and predict outcomes. This opinion paper summarizes current evidence supporting the use of a core panel of laboratory tests in the initial evaluation of patients with emergency bleeding admitted to the ED. The leading characteristics of these initial tests encompass elevated diagnostic sensitivity, high precision and reproducibility, broad analytical measurement range, minimal turnaround time, low sample volume requirements, continuous availability, accessible measurement uncertainty, and proven clinical impact. The hypothetical core tests may include hemoglobin, blood lactate, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, platelet count, viscoelastic assays, specific tests for measuring direct oral anticoagulants (DOACs), cardiac troponins and other organ-specific tests in patients with signs and symptoms of hypovolemic shock-induced organ failure. We believe that early implementation of a targeted, evidence-based initial laboratory diagnostic strategy in patients presenting to the ED with severely acute bleeding may support more effective resuscitation and transfusion protocols, reduce unnecessary interventions, and improve clinical outcomes.