Acquired Coagulation Disorders

Acquired Coagulation Disorders

  • Liver Disease
    • Most blood coagulation factors are synthesized in the liver. If the liver is dysfunctional due to an underlying condition or any abnormality, a decrease in the number of the coagulation factor occurs. Laboratories will show a prolonged PT (except if with Vitamin K deficiency) if there is indeed a hepatic dysfunction and alteration. Bleeding would be the major presentation of the condition and the patient will be continuously at risk for significant bleeding episodes. To manage this condition, fresh frozen plasma may be transfused to replace the clotting factors. It will also be used to eventually stop or avert bleeding. Internal hemorrhages are also possible so fresh frozen plasma, RBCs and platelets should be ready in case transfusion is indicated.
    • Vitamin K Deficiency
      • Vitamin K is very important in preventing bleeding episodes. Some however have decreased levels of vitamin K that may be due to a certain deficiency, malnutrition or medication reaction. If stored levels of vitamin K is decreased, then the synthetization of coagulation factors are affected (decreased). Oral or intravenous administration of Vitamin K is done to reach the adequate level of Vitamin K needed for coagulation factor synthesis.
      • Complications  of Anti – Coagulation Therapy
        • To prevent DVT or thrombosis, anti – coagulant therapy is initiated. The two medications usually administered are heparin and warfarin. These two however can result to bleeding. If laboratories will show a prolonged PT and PTT (longer than normal), then medication administration should be stopped or the dosage be decrease. Vitamin K is administered to stop the bleeding and to act on warfarin toxicity. If bleeding is rather significant, fresh frozen plasma should be transfused, taking over the vitamin K.
        • Disseminated Intravascular Coagulation (DIC)
          • Disseminated intravascular coagulation is due to an underlying condition. DIC involves alteration in the hemostatic mechanism of the body. If the platelets and clotting factors are consumed, coagulation fails. There might be excessive clot formation or excessive bleeding. Signs and symptoms include bleeding from almost all body orifices, mucus membranes, gastrointestinal tract, urinary tract and venipuncture sites. There could be organ dysfuntions such as renal failure and pulmonary infarctions. Management lies on treating the underlying cause. If this is controlled, then treatment will proceed to oxygenation therapy, intravenous fluid therapy and correcting electrolyte imbalance. Cyoprecipitate is administered to replace fibrinogen and factors V and VII. Fresh frozen plasma is given to replace other coagulation factors.

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

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