THROMBOCYTOPENIA

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THROMBOCYTOPENIA
- reduced platelet count -
First of all . . what are platelets?
 Platelets: tiny cells
that circulate in the
blood and whose
function is to take part
in the clotting
process.
 Average lifespan of a
platelet in the blood is
10 days.
What is Thrombocytopenia?
 Definition: an abnormal hematological condition
in which the number of platelets is reduced to
fewer than 150,000/mm³.
 this deficiency alters the process of
coagulation.
 normal platelet count range is 150,000 –
400,000/mm³.
Causes.
What can cause Thrombocytopenia?
Decreased production of platelets.
Aplastic Anemia.
Decreased platelet survival.
Diseminated intravascular
coagulation.
(DIC)
Antibody destruction.
Leukemia.
Infection.
Tumors.
Thrombocytopneic purpura.
Viral invasion.
Chemotherapy.
Increased platelet destruction.
Let’s take a look at Thrombocytopenia
purpura . .
 Most common
cause of increased
destruction of
platelets.
 May be immune or
drug induced.
 Immune thrombocytopenic
purpura (ITP) –
• In ITP platelets are coated
with antibodies.
• Spleen doesn’t recognize
them and macrophages
destroy them.
 Drug induced
thrombocytopenic purpura –
• To determine the strength of
clinical evidence for
individual drugs as a cause
of thrombocytopenia. .
• Patients platelet count will
return to normal 1 – 2 weeks
after medication is
withdrawn..
Clinical Manifestations.
 Most common
observable signs:
 Petechiae
• Capillary hemorrhage
 Eccymoses
• Bruising
Platelet levels & risks.
 The severity of signs and symptoms are
related specifically to the platelet count.
 If platelet level drops below 100,000/mm³, the
risk for bleeding from mucous membranes, in
cutaneous sites and internal organs increases.
 If platelet level drops below 5000/mm³,
spontaneous, potentially fatal CNS or GI
hemorrhage can occur.
Assessment time . .
 Subjective Data.
 Question patient
about recent viral
infections.
 Medications in current
use.
 Extent of alcohol
ingestion.
 Objective Data.
 Observe patient for
petechiae and
ecchymoses
throughout skin.
 Epistaxis and gingival
bleeding.
 Signs of increased
intracranial pressure
caused by cerebral
hemorrhage.
Diagnostic Tests.
 Complete lab studies to determine the
characteristics of all blood cells, including:
• Platelet count.
• Peripheral blood smear.
• Bleeding time.
 Bone marrow aspiration to determine the
presence of immature platelets and
abnormalities of the bone marrow (eg.
Neoplastic invastion or aplastic anemia).
Medical Management.
 Corticosteroid
therapy.

these have the ability to suppress
the phagocytic response of
splenic macrophages.
 Intravenous
immunoglobulin /
immunosuppresive
drugs.

blocks antibody receptors in the
macrophages.
 Splenectomy.

removes the spleen in order to
stop the splenic macrophages
from destroying platelets.
 Tranfusions with
platelet concentrates.
Nursing Interventions.
 Prevent infection and  Monitor potential sites
trauma by practicing
for hemorrhage.
meticulous asepsis
and gentle handling of  Maintain comfort
patients.
measures and bed
rest.
 Check patient’s urine,
stool and emesis for
 Always monitor vital
blood.
signs.
Patient Teaching.
 Inform patient of all signs and symptoms, and
importance of notifying physician with any
bleeding.
 Teach preventative measures such as:






avoid trauma
use stool softeners
maintain a high-fiber diet to prevent constipation
always check for presence of blood
use a soft toothbrush
blow nose gently
Prognosis.
Variable.
 Depends on the underlying cause.
 80% of patients benefit from splenectomy.
 With ITP – treatment needs to be administered
3 – 4 weeks before complete response is seen.

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