Coagulopathies

Hemostasis can fail in two opposite directions: inadequate clot formation causes bleeding, while excessive or poorly regulated clotting causes thrombosis. The same patient may have both, as in disseminated intravascular coagulation (DIC) or heparin-induced thrombocytopenia (HIT). Begin with the clinical pattern rather than a single abnormal result. Immediate petechiae, purpura, epistaxis, or gum bleeding points toward a platelet or von Willebrand factor problem. Delayed bleeding into joints, muscles, or deep tissue points toward a coagulation-factor problem. A falling platelet count after heparin exposure is different: it signals a prothrombotic emergency until HIT is excluded. For a Canadian nurse practitioner, assessment and prescribing occur within provincial legislation, employer privileges, transfusion-medicine policy, and available hematology support. Blood products, reversal agents, and massive hemorrhage pathways must follow the local hospital or provincial protocol.