1. Coagulation Disorders

2. Drugs Anticoagulants Antiplatelets Thrombolytics Hemostatics
Parenteral = Heparin
Enteral = Warfarin
Antiplatelets
Clopidogrel (Plavix)
Thrombolytics
Alteplase (activase)
Hemostatics
Amicar

3. Hemostasis Stopping of blood flow
Involves large number of enzymes and clotting factors
Final product is a fibrin clot that stops blood loss

4. Figure 27.1 Basic Steps in Hemostasis
Platelets gather at wound & attempt to block blood flow
Calcium, Vitamin K, fibrinogen help platelets form clot when exposed to air
Fibrinogen fibrin, weblike mesh trapping blood cells in “scab”

5. Coagulation Cascade Injured cells release prothrombin activator
Prothrombin activator changes prothrombin to thrombin.
Thrombin changes fibrinogen to fibrin
Fibrin forms insoluble web over injured area to stop blood flow

6. Fibrinolysis Clot removal
Initiated by release of tissue plasminogen activator (tPA)
tPA converts plaminogen to plasmin
Plasmin digests fibrin strands – thus, circulation is restored
Regulated so unwanted clots are removed and fibrin is left in wounds

7. Diseases of Hemostasis
Thromboembolic disorders (need anticoagulants)
Thrombus, embolus
DVT
Thrombocytopenia
Bleeding disorders (Hemophilia)

8. Coagulation Modifiers
Anticoagulants
Thrombolytics
Hemostatics

9. Lab Tests that Measure Coagulation
Used for diagnosing and treating coagulation disorders
Prothrombin time (PT)
International normalized ratio (INR)
Thrombin time
Activated partial thromboplastin (aPTT)
Liver function tests
Bleeding time
Platelet count (CBC)

10. Role of Nurse ANTICOAGULANTS
Most serious side effect to assess is bleeding
To assess internal bleeding
Monitor CBC, abdominal bulging, guaiac tests on stool
Essential for patient safety to assess coagulation studies
Monitor intake of vitamin K-rich foods; limit intake of garlic
Heparin (Heplock) Indirect thrombin inhibitor;
Warfarin (Coumadin) Vitamin K Antagonist

11. Role of Nurse ANTIPLATELET AGENTS
Monitor for bleeding
Risk increases if given with anticoagulants
Prolonged pressure needed to control bleeding at puncture sites
Clopidogrel (Plavix)
Antiplatelet drug

12. Role of Nurse THROMBOLYTICS
To dissolve existing clots
To treat acute myocardial infarction, deep vein thrombosis
To treat cerebrovascular accident, pulmonary embolism, arterial thrombosis
To clear IV catheters
Alteplase (Activase)

13. Role of Nurse HEMOSTATICS
To promote formation of clots by preventing and treating excessive bleeding from surgical sites
Aminocaproic Acid (Amicar)

14. Hematopoietic Disorders

15. Drugs Hematopoietic Growth Factors Antianemic Drugs
Erythropoietin aka epoeitin alfa (Epogen)
Colony stimulatin aka filgrastim (Neuopogen)
Antianemic Drugs
Cyanocobalamin (Nascobal)
Ferrous sulfate

16. HEMATOPOIESIS Process of blood-cell formation
Begins with stem cell in bone marrow
Erythrocytes (erythropoiesis) –RBC
Leukocytes (leukopoiesis) –WBC
Platelets (thrombocytopoiesis)

17. Hematopoiesis

18. Anemias Blood has reduced capacity to carry oxygen
Erythrocyte loss due to hemorrhage
Excessive erythrocyte destruction
Impaired erythrocyte production
Anemia is a sign, not a distinct disease

19. Anemias Classification of Anemias
Common Signs and Symptoms
A description of the erythrocyte’s size and color.
Sizes are described as
normal (normocytic)
small (microcytic
large (macrocytic).
Color is based on the amount of hemoglobin present and described as
normal red (normochromic) or
light red (hypochromic).
Pallor of skin and mucus membranes
Decreased exercise tolerance
Fatigue and lethargy, dizziness and fainting
Increased respiratory rate and heart rate
Heart failure

20. Vitamin B12 Deficiency = Pernicious or Megaloblastic
Absence of intrinsic factor, protein secreted by stomach cells required for Vitamin B12 to be absorbed from intestines.
Vitamin B12 & Folic Acid

21. Iron Deficiency Anemia
Iron is an important building block for red blood cells.
Without iron, blood cannot carry oxygen effectively.

22. Role of the Nurse Careful monitoring of client’s condition
Providing education as it relates to prescribed drug treatment
Assess medical, drug, dietary, and lifestyle history
Obtain baseline complete blood count and vital signs

23. Prototype Drugs Epoetin Alfa (Epogen, Procrit) –anemia
Filgastrim (Neupogen) –increase neutrophil production
Cyanocobalamin (Vitamin B12) –anemia/vitamin supplement
Ferrous Sulfate (Feosol) –anemia/iron supplement