Page 210 - Critical Care Notes

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HEMA/
ONCO
■ Educate patient’s family members to avoid visiting if they have cold or flu-
like symptoms.
■ Maintain good hand washing procedures.
Coagulopathy
Abnormalities in blood coagulation may comprise a large number of disorders,
including deficiency (or single-factor) abnormalities and acquired forms associ-
ated with multiple coagulation abnormalities. The disorders are discussed here.
Vitamin K Deficiency
Vitamin K deficiency occurs when stores of this vitamin are deficient or abnor-
mal, causing inhibition of normal coagulation.
Pathophysiology
■ Prothrombin factors VII, IX, and X (FVII, FIX, and FX) and proteins C and S
are synthesized by the liver through a process that depends on vitamin K.
■ Vitamin K deficiency → synthesized hypofunctional by-products → inhibition
of normal coagulation. These byproducts do not bind to cellular phospho-
lipid surfaces and therefore do not participate in cell-associated coagulation
reactions. Coumadin produces a similar coagulation abnormality that antag-
onizes the action of vitamin K.
■ Because vitamin K is fat soluble, the absorption from the GI tract is
decreased in biliary obstruction and in fat malabsorption syndromes.
■ Antibiotics that inhibit gut flora decrease the amount of vitamin K ordinarily
supplied by these organisms.
Clinical Presentation
■ Epistaxis and/or bleeding from puncture sites or invasive lines, wounds
■ Prolonged PT and elevated INR
Diagnostic Tests
■ PT (most sensitive early indicator)
Management
■ Administer FFP (treatment of choice for acute hemorrhage or to reverse for
a procedure).
■ Administer vitamin K (1–10 mg × 3 days).
■ Continue to monitor PT.
■ Assess for bleeding.
■ Provide emotional support to patient and family.
Liver Disease
Coagulation disorder caused by liver disease is multifactorial and involves ↓
synthesis of coagulation proteins, ↑ clearance of FDPs, and ↑ fibrinolysis.
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