Bleeding and Coagulopathies in Critical Care unit

Abstract

oagulopathy is a condition in which the blood’s ability to coagulate is impaired. This condition can cause a tendency toward prolonged or excessive bleeding, which may occur spontaneously or following an injury or medical and dental procedures. Of note, coagulopathies are sometimes erroneously referred to as "clotting disorders"; a clotting disorder is a predisposition to clot formation.Normal coagulation is a balance between hemostatic and fibrinolytic processes which permit control of bleeding following mild injury while preventing inappropriate intravascular thrombosis. The liver is the site of production of almost all of the numbered coagulation factors including fibrinogen (factor I), thrombin (factor II), and upstream factors V, VII, IX, X, and XI. Notable exceptions are factor VIII, which is produced in endothelial cells, and the factor XIII A-subunit, which is produced in the bone marrow.In addition to synthesizing coagulation proteins, hepatocytes also make post-translational modifications such as glycosylation and gamma-carboxylation of some factors. Coagulopathy is a potential problem for many critically ill patients, placing them at risk for hemorrhage. Critical illness activates both hemostasis and the inflammatory-