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Change Bleeding20clotting20and20platelets20disorders-220205073717
Change Bleeding20clotting20and20platelets20disorders-220205073717
Change Bleeding20clotting20and20platelets20disorders-220205073717
Hemophilia
Hypoprothrombinemia
Disseminated
intravascular
coagulation Thrombocytopenia
WHAT IS HAEMOPHILLIA?
Hemophilia is a common hereditary coagulation blood disorder
due to deficiency or reduced activity of clotting factor VIII or
clotting factor IX. This disorder is a X- linked recessive disorder.
Hemophilia is a bleeding disorder that slows down the blood
clotting process.
It is transmitted by females to men who are sufferers
People who have hemophilia often have longer bleeding after
some sort of contact to injury. people who have severe
hemophilia start to have spontaneous bleeding in the joints and
muscles or all around their bodies. Hemophilia is more common
in males than females.
There are three main types of hemophilia:
A B C
It is the most common It is the second most It is a mild form of
type of hemophilia type of hemophilia hemophilia
(severe) (moderate) (mild)
It is also known as It was originally named Deficiency of factor XI.
factor VIII deficiency or “Christmas disease”
classic hemophilia Caused by factor IX
deficiency.
INHERITANCE DIAGRAM
ETIOLOGY/PATHOPHYSIOLOGY
CAUSES OF HEMOPHILIA
NURSING INTERVENTIONS
Immobilise joints and apply elastic bandages to the affected
joint if indicated.
Elevate the affected part
Apply a cold compress to active bleeding sites.
Provide gentle passive ROM exercises
NURSING DIAGNOSIS 2
Risk for bleeding related to decreased concentration of clotting
factors circulating in the blood [factor VIII or IX]
NURSING INTERVENTIONS
Monitor hemoglobin and hematocrit levels
Assess for inhibitor antibodies to factor VIII
Anticipate the need for prophylactic treatment before high risk
situation such as invasive diagnosis or surgical procedure
Provide replacement therapy of deficient clotting factors.
NURSING DIAGNOSIS 3
Risks for injury related to decreased clotting factor(VIII or IX)
NURSING INTERVENTIONS
Provide appropriate oral hygiene ( use of water irrigation
device, use of soft/ sponge tipped toothbrush)
Avoid rectal temperature
Use of padded bed rail sides.
WHAT IS DISSEMINATED
INTRAVASCULAR COAGULATION?
Disseminated Intravascular Coagulation (DIC) is a rare but
serious condition that causes abnormal blood clotting throughout
the body’s blood vessels.
It is caused by another disease or condition, such as an infection
or injury, that makes the body’s normal blood clotting prcess
become overactive.
DIC may develop quickly over hours or days, or more slowly.
ETIOLOGY
DIC is not a disease, it’s an abnormal response of the normal
clotting cascade stimulated by another disease process or
disorders. The diseases and disorders are known to predispose
the patient with DIC are as follows:
1. Acute DIC
• Shock hemorrhagic
• Septicemia
• Hemolytic process
NURSING INTERVENTIONS
Assess the heart rate and blood pressure of the patient.
Observe for signs of external bleeding from the
gastrointestinal and genitourinary tract
Monitor hemoglobin and hematocrit levels.
WHAT IS
HYPOPROTHROMBINEMIA?
Defined as prothrombin deficiency in the blood usually due to
vitamin K deficiency or liver disease (especially obstructive
jaundice) and resulting in delayed clotting of blood or
spontaneous bleeding (as from the nose or into the skin, also
called prothrombinopenia.
ETIOLOGY
Hypoprothrombinemia can be the result of:
Genetic defect
May be acquired as a result of another disease process
Adverse effects of medication
Exclusively breast-fed infants are acquiring lower vitamin K as
compared to formula-fed infants.
Vitamin K deficiency
Severe liver disease
Disseminated intravascular coagulation (DIC)
Warfarin overdose
PATHOPHYSIOLOGY
Hypoprothrombinemia, disease characterised by a deficiency of
the blood clotting substance prothrombin, resulting in a tendency
of prolonged bleeding
It is usually associated with a lack of vitamin K which is
necessary for the synthesis of prothrombin in the liver cells
In adults, this condition occurs most commonly in cases of
obstructive jaundice in which the flow of bile to the bowel is
interrupted ; bile is necessary for the intestinal abortion of vitamin
K
In the newborn, a lack of prothrombin leads too a condition
known as Hemorrhagic disease of the newborn,characterised by
spontaneous internal and external hemorrhage although this
abnormal bleeding tends to run a short, self- limited course,it can
sometimes have fatal outcomes.
CLINICAL MANIFESTATIONS
The major manifestations of hypoprothrombinemia are:
NURSING INTERVENTION
Review laboratory results for coagulation such as platelet
count, prothrombin time (PT) activated partial thromboplastin
time (aPTT) ,fibrinogen, bleeding time, fibrin degradation
products, activated coagulation time(ACT)
NURSING DIAGNSIS 2
Potential for injury related to formation of venous thrombus
NURSING INTERVENTION
to decrease the incidence of thrombus in the pelvic veins/
deep leg veins, exercises are done
Adequate hydration is given to the patient
Avoid the patient having venous constriction such as crossing
legs, wearing stockings or any garments that compress the leg
veins
NURSING DIAGNOSIS 3
Potential for injury related to heparin therapy
NURSING INTERVENTION
safely monitor the patient who is being anti- coagulated with
heparin
Do regular assessment to determine platelets count
Ensure that the patient receiving heparin is not taking other
medications that could potentiate or interfere with the intended
therapeutic action of heparin.
WHAT IS THROMBOCYTOPENIA?
Defined as the subnormal amount of platelets in the circulating
blood
Normal platelet count is 1.5 lakhs to 4.5 lakhs /microlitre.
Thrombocytopenia is defined as a platelet disorder having
platelet count less than 1.5 lakhs/ microlitre.
Not usually clinically detected until the platelet count falls to
levels below 1 lakh/ microlitre. However, a recent fall in the
platelet count by 50% while still in the norml range, may herald
severe clinical problems and require active follow- ups .Eg: HIT.
ETIOLOGY
Platelet disorders can be inherited but vast majority are acquired.
Acquired disorders occur because of decreased platelet
production, or increased platelet production and many
abnormalities occur following ingestions of some foods and
drugs.
1. Decreased platelet production
a. INHERITED
Fanconi’s Syndrome (Pancytopenia)
Hereditary Thrombocytopenia
b. ACQUIRED
Viral infections
Chronic alcoholism
Exposure to ionising radiations
Malignant hematologic disorder
ETIOLOGY
2. Increased platelet destruction
a) NON IMMUNE
Pregnancy
Infection
Severe burns
b) IMMUNE
Human immunodeficiency virus infection
Drugs induced
ETIOLOGY
3. Drugs, spices and vitamins causing abnormalities in platelet
function
a) SUPPRESSION OF PLATELET PRODUCTION
Thiazide diuretics, alcohol, estrogen and chemotherapeutic drugs
NURSING INTERVENTIONS:
Review laboratory results for coagulation status as appropriate
platelet count, prothrombin time, international normalized ratio (PT/
INR), activated partial thromboplastin time (aPTT), fibrinogen,
bleeding time, Vitamin K, activated coagulation time (ACT).
Educate the at- risk patients and caregivers about precautionary
measures to prevent tissue trauma.
NURSING DIAGNOSIS 2 :
risk for injury related to abnormal profile
NURSING INTERVENTION:
Thoroughly confirm patients to surroundings and teach how to call
for assistance.
Obtain a physician’s order if restraints needed
Eliminate or drop all possible hazards in the room such as razors,
medications and matches
NURSING DIAGNOSIS 3 :
risk for infection related to suppression of the immune system by
steroids.
NURSING INTERVENTIONS :
Teach patients about general hygiene such as washing of hands
Encourage fluid intake of 2,000- 3,000 ml of water each day, unless
contraindicated
In case of infection, encourage patients to take antibiotics as
prescribed, instruct patient to take full course of antibiotics even if the
symptoms disappear.
RESEARCH
New research by the Georgia Institute of Technology
and Emory University published in the journal “ Biomaterials”
sheds new light on the mechanics and physics of blood clotting
through modeling the dynamics at play during a still poorly
understood phase of blood clotting called Clot Contraction.
The workhorses to stop bleeding are the platelets –
which are tiny cells of 2 micrometre in the blood and responsible
for the initial plug. The clot that forms is fibrin strands, which act
as glue scaffold that platelets attach to .
Blood clot contraction arises when these platelets
interact with the fibrin scaffold. To demonstrate the contraction,
researchers embedded a 3 mm mould with millions of platelets
and fibrin to recreate a simplified version of a blood clot.
SUMMARY
The nurse is often involved in the administration of blood and
blood products for treatment of these various disorders . Many of
these blood disorders are life threatening, others are easily
controlled with proper nutrition or regular medications.