Med-Surg - Cardiovascular System, part 20: Polycythemia, Coagulation Disorders

by Cathy Parkes October 20, 2021 Updated: August 09, 2023 4 min read

Full Transcript

Hi, I'm Cathy, with Level Up RN. In this video, we are going to talk about polycythemia as well as coagulation disorders. At the end of the video, I'm going to provide you guys a little quiz to test your knowledge of some of the key facts I'll be covering in this video. So definitely stay tuned for that. And if you have our Level Up RN medical-surgical nursing flashcards, definitely pull those out so you can follow along with me.

Polycythemia is a rare blood disorder that causes an increase in red blood cells. We have primary polycythemia and secondary polycythemia.

With primary polycythemia, this is caused by a gene mutation that results in uncontrolled production of abnormal red blood cells.

And this makes the patient's blood thicker, which puts them at risk for clots. It also impairs blood flow such that the patient is at risk for ischemia.

With secondary polycythemia, this is due to long-term poor oxygenation that can be caused by a lung disorder or heart disorder.

So the body will try to compensate for this poor oxygenation by increasing production of red blood cells.

In terms of signs and symptoms, the patient may present with a ruddy complexion. So it's like a red type complexion. They may complain of dizziness, headache, and fatigue. You may see clubbing present on their fingernails, and they may also have an enlarged spleen.

In terms of diagnosis, if we run a CBC, their red blood cell count will be elevated, as well as their hematocrit. And then a bone marrow biopsy may be used as well.

In terms of treatment, there is no cure for this condition. However, we can do pheresis to remove some of the patient's red blood cells through phlebotomy.

Medications that are useful also include hydroxyurea, as well as aspirin.

We're now going to talk about coagulation disorders, which are caused by a deficiency in platelets and/or clotting factors, which increases bleeding.

Signs and symptoms of a coagulation disorder include excessive bleeding or bruising, oozing from an incision, petechiae, tachycardia, as well as hypotension.

So treatment of a coagulation disorder will depend on the specific disorder we're talking about, and we're going to get into a discussion about those specific disorders here in a minute. But, in general, we're likely going to administer blood products. We're going to perform fluid volume replacement, and administer oxygen. And then, we may need to give clotting factor replacement as well.

In terms of nursing care, we're going to want to limit the venipunctures and IM injections. We're going to want to implement fall precautions.

And then, we need to provide teaching to our patient. So they should use a soft toothbrush, an electric razor, and seek immediate medical attention for any kind of head trauma.

I'm now going to touch on some, but not all, of the specific coagulation disorders that we have on our flashcards.

Starting with hemophilia, which is a rare inherited bleeding disorder that results in a deficiency in clotting factors, so not platelets, clotting factors.

With hemophilia A, we have a deficiency in factor VIII. So A and VIII kind of sound similar. So that's how I remember those two go together.

With hemophilia B, we have a deficiency in factor IX. In terms of labs, we will see an increase in APTT. However, it's important to note that we will not see a difference in PT or platelets.

In terms of treatment, we're going to provide factor replacement.

All right. Next, we have ITP, which is an autoimmune disorder that causes a decrease in the life span of platelets.

So in terms of labs, we're going to see a decrease in platelets, but an increase in PT and APTT.

In terms of treatment, we're going to provide corticosteroids because this is an autoimmune disorder, and we're trying to suppress the immune response. We can also provide IVIG, and then a splenectomy may be necessary.

Next, we have HIT, which is heparin-induced thrombocytopenia. So this is an immune-mediated drug reaction to heparin that causes a drop in platelets.

So with labs, we will see a decrease in platelets. However, the patient will have a normal PT and APTT.

In terms of treatment, we're going to. Immediately take the patient off heparin and provide an alternative anticoagulant instead. And they will also require platelet transfusion.

And then finally, we have DIC, which is disseminated intravascular coagulation.

This is a disorder where clotting factors and platelets are depleted through the formation of micro clots throughout the body.

So in terms of labs, we're going to see a decrease in platelets and we're going to see an increase in PT, APTT, and D-dimer. And we have that increase in D-dimer because of all those clots.

In terms of treatment, we're going to provide the patient with clotting factors as well as a platelet and/or plasma transfusion.

All right. You guys ready for a quiz? I have three questions for you. First question. Polycythemia will make a patient's blood thicker, which increases the risk for clots. True or false? The answer is true. Question number two. Hemophilia causes a decrease in platelets. True or false? The answer is false. It causes a decrease in clotting factors. Platelets are normal. Question number three. What disorder is characterized by the depletion of clotting factors and platelets through the formation of thousands of micro clots in the body? The answer is DIC, disseminated intravascular coagulation. All right. That's it for this video. I hope you enjoyed it and I hope it was helpful. If so, be sure to like the video and leave me a comment. Take care and good luck with studying.

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