Question of The Day

Nurse is caring for a client with a GI bleed who has been diagnosed with liver failure due to hepatitis B. Which of the following blood products will most likely be prescribed to achieve hemostasis?

Answer in the comment section.

A. Packed red blood cells

B. Cryoprecipitate

C. Platelets

D. Whole blood

Correct Answer: B. 
Cryoprecipitate
 

The liver produces most coagulation factors, except factor VIII and factor XIII A-subunit. Individuals with liver disease are at risk of decreased synthesis due to decreased production capacity. Some clients may also have vitamin K deficiency. Vitamin K is necessary for the production of clotting factors II, VII, IX, and X. In individuals with hemorrhage and liver failure, cryoprecipitate or fresh frozen plasma is administered to provide clotting factors. Cryoprecipitate provides VIII, XIII, and fibrinogen. It is infused through a sterile infusion set with a filter. Side effects can include allergic reactions and febrile reactions. ABO compatibility testing is recommended, but Rh factor testing is unnecessary. Cryoprecipitate is stored frozen and thawed in a water bath for 15 minutes.

Incorrect Answers:
A. Packed red blood cells are given to increase hemoglobin and hematocrit.

C. Platelets play a small role in abnormalities of hemostasis in some individuals with liver disease, but low levels of coagulation factors are the primary underlying abnormality and can be corrected with cryoprecipitate or fresh frozen plasma. Platelet counts may be normal in some individuals with chronic liver disease. Others may have mild thrombocytopenia that doesn’t impact hemostasis. Clients with infection, uremia, and other conditions concurrent with liver failure may have reduced platelet dysfunction.

D. Whole blood is not used when components are available. Whole blood transfusion is associated with a higher rate of complications, including volume overload.

Vital Concept:
Liver failure results in decreased synthesis of clotting factors and increased risk of hemorrhage. Cirrhosis also results in esophageal varices, a common cause of upper GI bleeding. When treating an upper GI bleed in clients with liver disease, clotting factors can be replaced by administration of cryoprecipitate or fresh frozen plasma.

 
References:
Ignatavicius DD, et al. (2017). Medical-surgical Nursing: Patient-centered Collaborative Care. Philadelphia, PA: WB Saunders Co.
Peer Comparison
A
32%
B
33%
C
19%
D
16%
Difficulty level:
Hard