Blood Administration & Coagulation Disorders Flashcards
Autoimmune Thrombocytopenia Purpura(ITP)
An autoimmune disorder,
normal platelet production but the number of circulating platelets have decreased because the patient makes an antibody against the surface of their own platelets which then makes it possible for macrophages to eat up their own platelets, destruction of the antibody-coded platelets in the spleen.
When the platelet destruction exceeds the production, we have impaired clotting.
Possibly a virus cause
Signs and symptoms
mucous membranes-bleeding in the teeth during brushing or flossing,
large bruises, petechaie/rash on upper arms, legs and chest,
anemia(bleeding or blood loss), hemorrhagic stroke(monitor neurological and mental status).
Diagnosed by
low platelet count and megakaryocytes in their bone marrow.
Megakaryocytes are precursors to thrombocytes
Antiplatelet antibody detected in their blood and H&H will decrease.
Once the platelet count becomes less than 50,000-engage in thrombocytopenic precaution.
Medications
Immunosuppressants, corticosteroids
Platelets become less than 10,000
Transfuse them with platelets
You may transfuse them with platelets but
the spleen is going to eat them just as you transfuse them platelets.
Monitor them
Bleeding Precautions
Avoiding IM injections Use a lift sheet Instruct the patient not to blow their nose Use the smallest needle for the task when they bump into a furniture, apply ice for an hour Test urine and stool for occult blood Look at IV sites for blood trickling Nothing by rectum Measure the abdominal girth daily Use electric shaver No flossing of the teeth Place patient on fall precaution Patients must wear firm shoes Furniture should be padded
Surgical intervention
Splenectomy
Post-op Splenectomy
Roll them over to check for bleeding
Dressing becomes saturated, reinforce dressings
If they are bleeding, get vital signs first before calling the surgeon.
Anybody that has had splenectomy is at risk for infections hence annual vaccination
Thrombocytopenia Purpura
Autoimmune disease, causes tissue ischemia, they can end up with MI, AKI, stroke, if untreated, fatal within 3 months,
They undergo platelet removal, infuse FFP to reduce the clumping, thin the plasma
Medications
Do not administer Aspirin, flecamycin and immunosuppressants
Hemophilia
hereditary disorder, Sex-linked, passed from mothers to son, 50% of passing it to daughters making them carriers and sons will have the disease
Two forms of hemophilia: Hemophilia A-factor VIII deficiency(accounts 80% of cases)and hemophilia B-factor IX deficiency(accounts 20% of cases) also know as Christmas disease.
they can produce platelet plugs but the clotting deficiency impairs the formation of the clots.
Signs and Symptoms of Hemophilia
Bleeding for minor cuts, bruises or abrasions
worry about bleeding into the joints-disabling arthritis,
tendency to bruise, prolonged hemorrhages after surgery, prolonged apTT, normal bleeding time and normal PT
Management
Hemophilia A- managed by Regular infusion of factor VIII PRN(administer before bleeding).
Anybody at risk for bleeding, look for swelling. It indicates they are bleeding(internally), look for tachycardia and other signs of shock
Hemophilia B is managed by infusion of factor IX(recombinant)
Heparin-induced thrombocytopenia
results from receiving unfractionated heparin or heparin product.
Higher incidence in females and also people who are exposed to heparin for more than a week
Ask people if they have been to the hospital for more than 100 days
ask symptoms of VTE
Look for thrombocytopenia after heparin exposure(hallmark sign)
Treatment
Administer anticoagulants -Direct thrombin inhibitors.
Once you bleed, you start clotting and clotting
