Hemostasis

Question 1

Thrombocytopenia

Answer 1

Abnormally LOW plts (<150,000)

Decreased production of plts - Cancers, drugs, ITP, infections, radiations

Increased destructions plts - DIC, HIT, TTP, HUS

Abnormal Plt Distribution - Drugs
Dilution, Splenic Sequestration, Chemo, ASA

Question 2

Causes

Answer 2

Plt Disorder
Leukaemia
Anemia
Trauma
Enlarged Spleen
Liver Diseases
Ethanol
Tx with heparin, ASA, chemo
Sepsis

Question 3

Clinical Manifestation

Answer 3

BLEEDING
Nosebleeds
Bleeding Gums
Petechiae = flat, reddish brown macules
Purpura = many petechiae

Prolonged bleeding <50,000
Spontaneous, life-threatening bleeding < 20,000

Question 4

Dx

Answer 4

LABS
Plts <150,000
HgB Normal/slightly low
PT/aPTT = Normal
Specific assays = PF4 heparing complex HIT

BONE MARROW Bx
Assess problems plt production (leukemia, aplastic anemia)

Question 5

PLTs

Answer 5

Agitate the bag periodically because it prevents clumping and administer as fast as tolerated

DO NOT need to check ABO compatibility

Indicated for bleeding caused by thrombocytopenia and plt count < 20,000

Made from fresh whole blood, keep at room temp, good for 1-5 days

Question 6

Nursing Care

Answer 6

GOALS = no bleeding, maintain vasculature integrity, manage self-care

Decrease bleeding risks
Bowel regimen - prevent constipation
Use soft toothbrushes
Avoid physical activity leading to trauma
Avoid medications that can affect coagulation factors and increase bleeding risks
Use electric razors
Avoid unnecessary venipunctures/invasive procedures (avoid IM injections, lower gauge needles for SubQ)
Avoid sharp objects and do not go barefoot
High Fowler’s position, pressure to nose, ice packs for nose bleeds

Question 7

HIT (Heparin Induced Thrombocytopenia)

Answer 7

PLT count drops (before or after) heparin therapy by 50% of baseline/plt count < 150,000

PLT4 = HALLMARK

Question 8

TX of HIT

Answer 8

STOP HEPARIN
Give alternatives such as argatroban (direct thrombin inhibitor)

Plasmapheresis (severe case) = Blood taken out, remove antibodies and clotting factors, exchanges plasma, and filtered whole blood returned to patient

NO PLT Transfusions - reaction will continue and enhance thrombotic events

AVOID HEPARIN and LMWH
list as an allergy

Question 9

Disseminated Intravascular Coagulation (DIC) Causes

Answer 9

Cancers
Sepsis
Transfusion of Mismatched Blood
Cardiac Arrest
Extensive Burns/Trauma
HELP Syndrome

Question 10

DIC Patho

Answer 10

BOTH Clotting and Bleeding

Use up more plts and clotting factors causing clots to form blocking perfusion to organs (ischemia)

Because clotting factors and platelets are limiting, increased bleeding with injury

Question 11

Manifestations Bleeding

Answer 11

Pale skin, petechiae (small red dots), purpura (larger groups of red dots), oozing blood @ venipuncture sites, leaky blood around IV site, occult blood, hematomas

Question 12

Clinical Manifestations DIC

Answer 12

Delirium/coma, changes in vision, dizziness, h/a, changes in LOC

Hemothoraz, hemoptysis, increased RR, ARDS, PE

Increased HR, low BP, changes in ECG

GI Bleeding, abdominal distention, pain, paralytic ileus

Joint and Bone pain

Blood in urine, oliguria, kidney failure

Cyanosis/tissue necrosis

Question 13

Dx DIC

Answer 13

LOW plt, fibrinogen
HIGH PT/PTT, D-dimer
(+) schistocytes, helmet cells (fragments of WBCs)

Question 14

Tx DIC

Answer 14

TX UNDERLYING CAUSE

BLEEDING
O2 supp. + volume replacement
Blood products - Cyro (clotting factor 8 and fibrinogen), FFP (fresh frozen plasma) (all clotting factors + anti-thrombin EXCEPT plts)

THROMBOSIS
heparin, LMWH

Question 15

Nursing Care DIC

Answer 15

Assess for petechiae, oozing around IV, or infection sites (external s/s of bleeding)

Assess for tachycardia, altered LOC, abdominal distention, pain (internal s/s of bleeding)

S/S of organ damage (low UOP)