Increased Risk of Bleeding: Lab Values – Complications of Liver Cirrhosis (Nursing)

00:00 Now let's look at Labs that we use to monitor for risk of bleeding.

00:04 I'm just talking an any patient.

00:06 If we want to check someone's going to go into surgery.

00:08 What are the types of lab work that we use to see if they're at risk for bleeding because patients undergoing surgery and risk for bleeding is definitely a bad thing.

00:18 So I want you to keep in mind these are routine labs that we use to assess patients who have cirrhosis because we know they're didn't risk for bleeding, but you'll also see these labs commonly ordered for anyone else that were interested in their risk of bleeding.

00:32 First one INR, second one aPTT, third one bleeding time and fourth one is a platelet count.

00:41 So these are four labs who specific focus is to help us identify if this patient is at a risk for bleeding.

00:49 Now why is there a giant red X over each one of those values? Because here's the problem.

00:56 Coagulation changes in cirrhosis make the traditional test like we just talked about, the INR, the aPTT, the bleeding time and the platelet count.

01:04 These are less than precise.

01:06 In fact, we even call them imprecise.

01:09 Because they don't predict a patient's risk of bleeding.

01:12 Now that's what research has showed us in the last five years.

01:16 So you may see these referred to in your textbook.

01:19 They are still excellent and reliable test unless the patient has some real changes due to cirrhosis.

01:26 So keep that in mind, we have to do something different with them.

01:29 So what are we looking for if a patient has cirrhosis? Remember cirrhosis can cause a range of changes to the patient's ability to clot and their risk of bleeding.

01:39 So the values may be abnormal or they may not be so you need to evaluate the results in the context of the individual patient and the liver damage.

01:50 So collaborate with the health care provider determine the best plan of care and how this particular patient should be assessed to keep them safe.

01:59 Now, let's look at the normal range for these tests.

02:01 Now we know that the potential for extreme changes for clotting and bleeding in mind for a patient.

02:06 We keep that in mind for someone who have cirrhosis, but let's look a little closer at one of the most common test the PT/INR.

02:13 So PT means Prothrombin time, normal is 11 to 35 seconds.

02:18 INR is the international normalized ratio.

02:22 Now, here's the cool part PT can have different timing depending on where you are, which lab, but an INR is a number that is consistent.

02:33 It's normalized.

02:35 So if my INR value is 1.0 at this lab, it will also be 1.0 at another lab.

02:43 How often does that happen? Not very but the normal ranges for an INR are going to be the same because they've been normalized.

02:52 Keeping in mind a diseased or damaged liver cannot make adequate amounts of proteins that are necessary for clotting.

03:00 Remember our friend, fibrinogen.

03:03 So if the PT/INR is elevated, the patient is an increased risk for bleeding.

03:08 Whether they have liver damage or not if these lab values are elevated than they are at an increased risk for bleeding.

03:16 Now we talked about that INR.

03:17 Let me explain a little bit more see an INR is the PT test / the PT normal.

03:23 You don't need to worry about that.

03:24 What you want to keep in mind is this has been normalized.

03:28 That's a value that you can compare from lab to lab and know that it's going to be consistent.

03:34 Which is a very good thing because we often decide medication dosages based on this number.

03:41 So let's update the original question this video series.

03:44 We've got nurse Natalie here and she's always friendly.

03:48 So let's break it down.

03:50 Now when we said it's complicated is bleeding, is it clotting? Keep in mind PT/INR may not be as accurate for patients with liver damage, but that doesn't mean we don't use that test.

04:01 Evidence based practice or EBP is beginning to support that PT/INR is really better for monitoring a patient is taking warfarin therapy versus the bleeding risk of the patient with cirrhosis.

04:14 Doesn't mean we'll use it but we do need to keep in mind that it may not be as accurate as we once thought it was.

04:21 If a patient with liver disease has an elevated PT/INR this may not accurately indicate how high the risk of bleeding is compared to a patient who doesn't have cirrhosis.

04:33 So if I take two patients, one has cirrhosis, one does not and both have elevated PT/INRs It will likely not be as accurate or predictor in the patient with cirrhosis compared to the patient who doesn't.