HAEMATOLOGY MODULE: COAGULATION DISORDERS 1 Adult Medical-Surgical Nursing

Blood Coagulation (Clotting) Factors Platelets (thrombocytes) Prothrombin Other clotting factors: VIII and IX Fibrinogen (Vitamin K and Calcium required)

Anticoagulants Plasminogen → plasmin Factor C Heparin These maintain balance by opposing the clotting factors: Prevent unnecessary clotting Enable dissolution of clots

Blood Coagulation Injury occurs Stimulates vasoconstriction to reduce blood flow to the area Platelets adhere forming an initial plug Thromboplastin released: Converts prothrombin → thrombin Thrombin converts fibrinogen → fibrin (mesh) Plasminogen to plasmin (control)

Thrombosis: Description Inappropriate blood clotting which usually leads to: Obstruction of blood vessels impeding blood flow Arterial Venous

Factors Increasing Risk of Thrombosis: Smoking Oral contraceptives / HRT (Oestrogen) Immobility Injury to blood vessels Poor circulation related to: Heart failure Varicose veins

Factors Reducing Risk of Thrombosis: Aspirin Anticoagulant medication Red wine Anti-embolic stockings

Complete Blood Count (CBC) including platelet count Prothrombin time/ PT International Normalised Ratio (INR) Partial prothrombin time/ PTT Activated PPT Fibrinogen, Fibrinogen Degradation Products (FDP), D - Dimers Bone Marrow Biopsy Coagulation Disorders: Diagnostic Tests

Fluids available to aid coagulation Fresh frozen plasma (FFP) Platelets Cryoprecipitate including: Fibrinogen, Factor VIII, Factor IX Whole blood Packed red cells Gamma globulin Anti-D

Coagulation Disorders: Classification Thrombocythaemia (In lecture 2): Thrombocytopenia Haemophilia (Factor VIII; IX) Von Willebrand Disorder Acquired Coagulation Disorder

Thrombocythaemia

Thrombocythaemia: Description Increased platelet production: >600,000 cmm 3 (ref ,000) Primary: no known cause Myeloprolific (bone marrow) disorder Secondary: Usually reaction to a malignant or inflammatory disorder/ splenectomy

Thrombocythaemia: Pathophysiology Increased platelet count Platelet dysfunction

Clinical Manifestations Increased platelet count: Vaso-occlusion of capillaries (thrombi) leads to: Visual disturbance Numbness and burning in extremities Platelet dysfunction: Haemorrhages: Gastro-intestinal, gums, epistaxis, petechiae, purpura

Thrombocythaemia: Diagnosis Patient history Clinical picture CBC (>600,000 mm 3 ) Bone marrow biopsy

Management and Nursing Care Low dose aspirin reduces the risk of thrombi Chemotherapy: &-interferon and hydroxyurea to control Platelet phoresis ↓ smoking Avoid NSAIDs/ alcohol Anti-embolism stockings