Warfarin (Coumadin)
Blood thinner
Heparin
Blood thinner (full effect in 6 hours)
Hemarthrosis
Bleeding into joint
Telangiectasia
Spider veins
Petechiae
Flat, pinpoint, nonblanching red or purple spots caused by capillary hemorrhages in the skin and mucus membranes
Purpura
When petechiae occur in groups or patches
Ecchymosis
Occurs when blood escapes into the tissues, producing a bruise
Hematoma
Blood knot
Hematochezia
- fresh blood found in stool
- Bright Red Blood Per Rectum (BRBPR)
- indicates lower GI bleed
- pooping blood (bright red color)
Melena
- Dark, sticky feces containing partly digested blood
- Black colored blood
Hematuria
Blood in urine
Hematemesis
- vomits blood
- coffee colored blood means patient is bleeding in upper GI tract
Epitaxis
Blood in nasal drainage
Hemoptysis
Blood in sputum
Menorrhagia
Excessive menstrual bleeding
PT (prothrombin time)/ INR (International Normalized Ratio)
Assesses the extrinsic pathway of coagulation
Prothrombin Time (PT)
- measures how quickly blood clots
- measures how thin blood is in response to Warfarin
- measured in seconds
International Normalized Ratio (INR)
- blood test to see how well your blood clots
- it is a ratio
- it is figured out using the results of the prothrombin time (used to standardize prothrombin time)
- higher INR, thinner the blood
- used to monitor Warfarin (Coumadin)
Normal INR range (aFib, aFeutten, DVT, PE)
2-3
INR range for mechanical heart valve
2.5-3.5
Activated Partial Thromboplastin Time (aPTT)
- measures the activity of the intrinsic and common pathways of coagulation
- used to monitor Heparin
- higher the time, thinner the blood
D-dimer
- reflects fibrinolysis
- high when presence of clot
- not diagnostic but presumptive
thrombocytopenia
Low platelet count
General mechanisms of thrombocytopenia
- decreased platelet production
- decreased platelet survival
- splenic sequestration
- intravascular dilution of circulating platelets
splenic sequestration
- common in people with Sickle Cell Disease
- happens when a lot of sickled red blood cells become trapped in the spleen
- spleen can enlarge, get damaged, and not work as it should
- when spleen doesn't work well, a person is more likely to have serious
Common causes of thrombocytopenia
- bone marrow suppression from chemotherapeutic
- recent immunizations
- alcohol ingestion - leads to bone marrow suppression
Clinical manifestations of thrombocytopenia
- low platelet count
- prolonged bleeding time
- petechiae
- purpura
Treatment of thrombocytopenia
Based on identified cause
Thrombocytosis
- platelet count greater than 400,000/ m3
- may bleed or clot
Types of thrombocytosis
- transitory - due to stress/ physical exercise
- primary - Polycythemia Vera or chronic granulocytic leukemia
- secondary - response to hemorrhage, disease process, or splenectomy
Treatment of thrombocytosis
- treatment reserved for primary etiologies (cytotoxic agents and anti-platelet or interferon therapy)
- no treatment for transitory and secondary
Coagulopathies
defects of the normal clotting mechanisms
Vitamin K Deficiency Bleeding in Infancy
- deficiency in vitamin K-dependent coagulation factors
- liver or gut not developed
- evidence of bleeding occurs early in life
- prophylactic administration of vitamin K to the newborn largely eliminated this coagulation disorder
- fresh plasma or blood
Acquired Vitamin K Deficiency
- fat soluble vitamin
- results in excessive bleeding
- PT/INR increased but other coagulation studies normal
- treatment: parenteral administration of vitamin K and to treat underlying condition
Disseminated Intravascular Coagulation (DIC)
- acquired hemorrhagic syndrome in which clotting and bleeding occur simultaneously
- causes include: trauma, malignancy, burns, shock, and abruptio placentae
- fibrinogen level and platelet count decreased
- increased bleeding time
- elevated PT/ INR/ aP
Treatment of DIC
- removal/ correction of underlying cause
- support major organs
- fresh frozen plasma, packed red blood cells, platelets, or cryoprecipitate
- Heparin used to minimize further consumption of clotting factors
Hepatic Disease
Coagulopathies result from:
- impaired absorption of vitamin K
- decreased synthesis of fibrinogen and number of clotting factors
- inability to remove activated coagulation factors and fibrinolytic proteins from circulation
- altered production of inhibi
Treatment of hepatic disease
- vitamin k administration
- platelet transfusion, fresh frozen plasma, or whole/ packed blood