Coagulopathy

Coagulopathy is a condition in which the blood's ability to coagulate is impaired. This would mean that if someone had a serious bleed, the bodies ability to form clots would be reduced, therefore it is hard to control the bleed. This condition can cause a tendency toward prolonged or excessive bleeding, which may occur spontaneously or following an injury or medical and dental procedures.

Coagulopathy is not just something that happens in the event of a serious bleed, but it is also a condition that people can suffer from and it gives a host of signs and symptoms. It can affect their life and the ability of their body to function correctly. Examples of problems are:

• Walking difficulties
• Convulsions or seizures
• Vision problems
• Confusion
• Loss of consciousness
• Blood in urine or stools
• Frequent nosebleeds
• Bleeding from the mouth and gums

There are different factors that increase the risk of coagulopathy and these include:

• Hypothermia
• Anticoagulant drug use, such as heparin or warfarin
• Hemophilia A or B
• Long-term use of antibiotics
• Severe liver disease
• Viral infections.

Coagulopathy is a real problem when trying to control a bleed as we want the blood to clot and therefore plug the wound. Any factors that decrease the clotting ability will make the condition worse.

There is a graphic that is used to show the factors affecting coagulopathy and this is sometimes called the trauma triad of death. The graphic shows three sides, the first is an increase in Latic acid in the blood causing Acidosis. The second is a decrease in the hearts performance and lack of blood volume causing hypothermia. Hypothermia can also be increased by the environment making things worse. And the final side shows a decrease in coagulation causing Coagulopathy.

In the case of a severe haemorrhage in trauma, as the oxygen delivery reduces, this can lead to hypothermia. This, in turn, can halt the coagulation cascade, preventing blood from clotting. In the absence of blood-bound oxygen and nutrients, the body's cells burn glucose anaerobically for energy, causing the release of lactic acid, ketone bodies, and other acidic compounds into the bloodstream, which lower the blood's pH, leading to metabolic acidosis. Such an increase in acidity damages the tissues and organs of the body and can reduce myocardial performance, further reducing the oxygen delivery. This cycle will continue and increases mortality rates if the cycle is not broken.

If we are dealing with a catastrophic bleed, we need the blood to clot and reduce coagulopathy so one important thing we can do it to keep the patient warm. Controlling heat loss can be maintained by the use of blankets and clothing to reduce heat loss. Another thing is to find out from the patient if possible is if they are on any blood-clotting drugs as this can make it more difficult to control bleeding.