ACTIVITY 4: Blood

Disorder
 OBJECTIVES:

1.To identify what is blood disorder and its associated symptoms.

2.To determine the risks and toxicities associated with warfarin

therapy.

3.To state the used of warfarin and its Mechanism of action.

WHAT IS BLOOD DISORDER?

 Any disease that affects one or more sections of

the blood, usually interfering with its ability to
function properly.
COMPONENTS OF BLOOD

 Red Blood Cell

 White Blood Cell

 Platelet
TYPES OF WHITE BLOOD CELL DISORDERS

 Lymphoma - is a type of cancer that occurs when lymphocytes change and

multiply rapidly. There are two major types of lymphoma: Hodgkin’s and
non-Hodgkin lymphoma.

 Leukemia - involve the build-up of abnormal white blood cells in the bone
marrow, which interferes with its ability to produce red blood cells and
platelets. Leukemia’s can be acute and develop quickly, or chronic and
develop more gradually over time.

 Myelomas - Myelomas involve the build-up of plasma cells in the bone

marrow, which interferes with the development and function of other blood
cells. The most common type of myeloma is Multiple Myeloma.
TYPES OF WHITE BLOOD CELL DISORDERS

Lymphoma Leukemia Myelomas

TREATMENTS

Blood cell cancers that do not yet caused symptoms may not
require treatment aside from monitoring. Doctors usually treat
people with aggressive or active blood cancers using some mix of :
Chemotherapy
Radiation therapy
Surgery
Targeted Drug Therapy
Stem Cell Transplants
TYPES OF RED BLOOD CELL DISORDER

Anemias - where there are not enough red blood cells or the cells do not
work correctly, are among the most common blood disorders. The most
common types are:
Iron-Deficiency Anemia
Pregnancy Anemia
Vitamin-Deficiency Anemia
Non-Inherited Hemolytic Anemia
Inherited Hemolytic Anemia
Aplastic Anemia
TREATMENTS

Treatment depends on the cause but commonly includes:

 Blood Transfusions, Dietary Changes, Surgery, Medications
that stimulate the production of bone marrow and new red
blood cells.
TYPES OF PLATELET CELL DISORDERS

 Hemophilia - a genetic condition caused by a lack of or defective clotting

factors in a person’s blood. People with hemophilia bleed longer or more
excessively, both externally and internally than people without the
condition.

 Von Willebrand Disease - this disease occurs when the body lacks the von
Willebrand factor (VWF), a substance that allows platelets to stick together
and form clots. Most cases of Von Willebrand are relatively mild, and people
may only require treatment if they are injured or undergo surgery.
TYPES OF PLATELET CELL DISORDERS

Hemophilia Von Willebrand Disease

TREATMENT AND DIAGNOSIS

Treating blood clotting disorders typically involves replacement therapy, where

the doctor gives a person infusions containing the specific clotting factors they
are lacking.
Additional therapies include:
Desmopressin - a synthetic hormone that promotes the release of von
Willebrand factor and factor VIII.

Anti-fibrinolytic Medications - that help prevent blood clots from

breaking down.

Birth Control Medications - to reduce heavy menstrual cycles.

Additional treatment options include:
 
 Blood Transfusions
 Corticosteroids to slow platelet destruction
 Immunoglobulins to block the immune system
 Surgery to remove the spleen in severe cases
“ Acalls62 911
year old man with a history of angina
complaining of crushing chest pain.
The 911 operator sends an ambulance and
instructs the patient to chew an aspirin while
waiting for the ambulance to arrive.
”
SCENARIO #1
QUESTIONS:

1. Why did the 911 operator have the patient take an

aspirin?
 The patient’s history of angina suggests he has Coronary Artery disease
and an elevated risk of Myocardial Infarction. His symptoms of crushing
chest pain may be indicated with those, therefore he was advised to
take and chew aspirin as an emergency medication, because a blood
clot might be forming in one of the patient’s artery blocking the blood
supply and oxygen distribution in the heart. Aspirin reduces the
clumping action of the platelets possibly preventing heart attacks. It
must be chewed to speed up its anti-blood clotting properties. Aspirin
works within 15 minutes to prevent the formation of blood clots.
 2. When the patient arrives at the hospital, he is diagnosed as
having a myocardial infarction and undergoes percutaneous
angioplasty to clear the clot in his coronary artery. He also
receives a stent to keep the vessel patent. What drugs will this
patient likely receive while in the to prevent recurrence of a
thrombus in the stented coronary vessel?

 The patient should take Clopidogrel together aspirin which

helps prevent blood clots after stent procedures and to keep
blood vessels open. And also, an anticoagulant Heparin can
be given to inhibit the formation of fibrin clots in the stented
coronary vessel.
 3. What drugs is this patient likely to receive being
discharged from the hospital?

 After being discharged, the patient should take a B- adrenergic

antagonist in order to reduced his risk of heart failure and
ventricular arrhythmias. To prevent reclusion of his illness, the
patient has to take a low dose aspirin and ADP receptor and
warfarin.
“ A 32 year old woman in good health is
discovered to have atrial fibrillation during a
routine checkup. She does not recall having
any symptoms of arrhythmia such as dizziness
or fainting, although she is not able to
exercise or as long as she could a few years
ago. Her cardiologist prescribes warfarin. ”
SCENARIO #2
QUESTIONS:

1.What is the rationale for using warfarin in this

patient?
 The patient has atrial fibrillation and she’s at risk on developing fibrin
clots that may lead to transients ischemic attacks, strokes and
Pulmonary embolism. The atria of patients with atrial fibrillation do
not contract properly causing blood pool in the atria and increasing he
chance of the formation of fibrin thrombus. The used of warfarin can
reduce the risk of fibrin clot formation because it is an oral
anticoagulant.
2. What is the mechanism of action of warfarin?

 The MOA of warfarin is that it decreases the body’s ability to form

blood clots by blocking the formation of vitamin K-dependent
clotting factors. And also, it competitively inhibits the VKORC1
which is an essential enzyme for activating vitamin K available in
the body.
3. What kinds of laboratory monitoring are required or
patients receiving warfarin only?

Laboratory monitoring used required for patients taking

warfarin is the Prothrombin time. It is used because it
measures the time it takes for a clot to form and also it
computes the measure that is commonly used to adjust the
warfarin dose.
4. What are the risks and toxicities associated with
warfarin therapy?

 Toxicity and risk occur when a person occur when a person take too
much warfarin in the body. Warfarin is a drug that used to prevent or
treatment for the formation of blood clots and the toxicities of it can
cause bleeding that can become life-threatening. There are signs and
symptoms that will also occur for warfarin toxicities such as red spot in
skin that look likes a rash, severe headache and dizziness, heavy
bleeding after injury, or during monthly period for women, severe
stomach pain or vomiting of blood, pink, red or brown urine or bloody
bowel movements.
5. What counselling should this patient receive?
 Since the patient has been given warfarin (a blood thinner) as medication for her condition
by the physician, she might need to be informed to avoid NSAIDS (non-steroidal anti-
inflammatory drugs) because they can increase the risk of bleeding for people who take
blood thinners. Patients taking warfarin should have blood (PT/INR) checked regularly. The
PT/INR level will show if your blood is too “thick” or too “thin”, which allows healthcare
provider to adjust warfarin dose as needed. Furthermore, because this patient is of child-
bearing age, she needs to be warned that warfarin causes birth defects and abortion. All
patients receiving warfarin should be educated to report any changes in medications
(including nonprescription drugs) or food supplements because of the large number of drug–
drug and food–drug interactions possible with warfarin that alter the pharmacokinetics and
efficacy of warfarin’s anticoagulant properties. Dietary changes can also affect warfarin
efficacy by altering the intake of vitamin K. For instance, changing to a diet that is rich in
green leafy vegetables (which are high in vitamin K) can lower the patient’s INR. The patient
should report any change in medications, dietary supplements, or significant change in diet
so that more frequent INR testing can be done and the results used to adjust warfarin
dosing.
6. Are there other oral anticoagulants that this
patient might be prescribed instead of warfarin?

Yes, there are other oral anticoagulant drugs such as

Dabigatran, Rivaroxaban and Apixaban. They have proven
to be as effective as warfarin to prevent clot formation.
Thus, they are considered as an alternative for people
with Atrial Fibrillation.
CONCLUSION