Nursing Considerations for Patients with Hemophilia

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Nursing Considerations for Hemophilia The article being presented is titled What every nurse should know about hemophilia and was written by Denise Hitch, BSN, RN. This article does a wonderful job summarizing the genetic factors leading to hemophilia, the varying types and severities of hemophilia, manifestations of the disease, and considerations nursing staff should take while caring for a patient with hemophilia. Hemophilia is an X-linked recessive genetic mutation. Beginning from conception, a patient with hemophilia will be given one of two X chromosomes from their mother. When they are given the X chromosome with a mutated gene for hemophilia and are female, they will have one functioning clotting gene and will have little to no manifestations of hemophilia. A male given the mutated X chromosome for hemophilia will only have the mutated gene and will have one of many varying expressions of hemophilia. Based on a percentage range of clotting factors (factor VIII for hemophilia A and factor IX for hemophilia B), a patient can have mild hemophilia (6-50%), moderate hemophilia (1-5%), or severe hemophilia (< 1%). While decreased levels of factors in the clotting cascade do not cause the patient to bleed faster, they do cause prolonged coagulation. It is easy to confuse bleeding disorders with clotting disorders. These patients often need infusions of clotting factors preoperatively or to treat major bleeds. Some minor bleeds like scrapes or superficial cuts can be treated normally whereas cranial bleeds, internal hemorrhaging, or joint bleeds need to be immediately addressed with infusions and prevented prophylactically. Joint bleeds in particular are detected early by the patient from pain and lack of mobility and these bleeds can lead to permanent damage of the joints. Alternative therapies for bleeds include RICE (rest, ice,

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