A group of inherited bleeding disorders in which
ability of blood to clot is impaired.
Type of Hemophilia
Hemophilia A ( Classic hemophilia )
Hemophilia B ( Christmas disease )
von Willebrand’s Disease
Deficiency of coagulation factor VIII
Deficiency of coagulation factor IX
von Willebrand Disease
Deficiency of von Willebrand protein
After 3 coagulation factor ( hemophilia A and B, von
Easy bruising and cutaneous hematoma
formation with minor trauma
Bleeding from gums and prolonged bleeding
following minor injuries or cuts
GIT bleeding with hematemesis, occult blood in
stools, gastric pain or abdominal pain
Spontaneous hematuria or epistaxis
Pain or paralysis due to pressure
hematomas on nerves
1) Blood Test
Help the doctor to check for certain disease and
It is also help to check the function of the organs and show how the
treatment are working.
2) Coagulations Study
(A) Partial Thromboplastin Time (PTT)
PTT is the blood test that looks how long it takes for
blood clot. It can help to tell if you have bleeding or
If the patient in heparin medication, you will be
watched for sign of bleeding.
TT is the blood test which measures the time it take for a
clot to form in the plasma from a blood sample in
anticoagulant which had added an excess of thrombin.
This test repeated with pooled plasma from normal patient.
Different in time between the test and the normal indicates
an abnormality in the conversion of fibrogen.
It is the test to measure how many platelet you
have in your blood. Platelet also can help the
The size is smaller than red and white blood cell.
Normal blood platelet
counts should be
3) Serum Platelet Level
Factor viii deficiency or extrinsic ( protein ) is an
inherited disorder in which a lack of plasma protein.
Factor viii leads to abnormal bleeding and it occurs
when the body does not have enough of factor vii.
It is very important blood clotting protein.
4) Factor Assay
The procedure that use to diagnose fetal defects
in the early second trimester of pregnancy
It is surrounds a fetus of womb
Performed on fetal cells found in the sample can
reveal the presence of many type of genetic
1. Fresh frozen plasma (FFP)
Replace all clotting factor except platelets
2. For Hemophilia A
Human blood serum
3. For Hemophilia B
Factor IX concentrate (only when needed as can
4. For Hemophilia C
Fresh frozen plasma daily
5. For Von Willebrand’s disease
Factor VIII concentrate
Aspirin is avoided in Hemophilia
Nursing Care Plan 1
Ineffective body protection related to lack of
Increasing patient body protection
Asses patient body protection by taking CBC to
evaluate patient condition
Instruct patient on bleeding precaution to promote
early intervention to prevent injury
Assist with administration of factor concentration,
fresh frozen plasma, cryoprecipitate or blood to
treat acute of bleeding.
If bleeding, apply cold compress at bleeding site
to help slow bleeding
Avoid any route of injection ( IM, IV,
Subcutaneous ) or rectal medication that cause
bleeding into tissue
Nursing Care Plan 2
Risk of aspiration related to uncontrolled nose
Reduce risk of aspiration
Control nose bleeding
Asses patient nose bleeding to evaluate
Apply cold compress to reduce nose bleeding
Avoid patient from expose with high
temperature to avoid nose bleeding
Avoid patient in doing major surgery to avoid
excessive bleeding (aspiration)
Replace clotting factor and blood product to
increase patient blood clotting.
Avoid all anticoagulant medication ( Heparin,
Aspirin )to control excessive bleeding.
Nursing Care Plan 3
Pain related bleeding into tissue
Patient will verbalize that pain is relieved to a
Asses patient pain by report the location,
intensity, and rate of pain (pain scale) to provide
caregiver with data for treatment plan.
Administer opiod (morphine) as prescribe to
control pain from severe to moderate.
Avoid IM injection because the risk of bleeding
into the muscle which can cause more pain
Reassess the level of pain within 1 hour after
administer opiod to determine the effectiveness
of treatment ordered.
Monitor sedation and respiratory status of the
patient receiving opiod of pain because opiod
can cause depress respiratory center of the brain