Abigail Del Fierro

Thrombocytopenia = decreased platelets ( < 150,000 / uL [150 x 10^9 / L]) from abnormal hemostasis

prolonged bleeds from minor trauma or spontaneous bleeds without injury

Etiology =

a. Inherited = fanconi syndrome (pancytopenia); hereditary thrombocytopenia

b. Acquired =

o Immune = immune thrombocytopenia purpura (ITP), neonatal alloimmune

thrombocytopenia;

o Non-immune = shorted circulated (increased consumption) thrombic

thrombocytopenia purpura (TTP); DIC; heparin-induced thrombocytopenia (HIT);

turbulent blood flow chemangiomas; abnormal cardiac valves; intra-aortic balloon

pumps; decreased production; drug/herbal induced

Signs/Symptoms: usually asymptomatic; bleeding (common); mucosal bleeds (epistaxis, gingival bleeds);

large bullous hemorrhage on buccal mucosa (d/t decreased vessel protection by submucosal tissue);

bleeds into skin (petechiae, purpura, superficial ecchymoses)

Lab findings =

1. Platelet count is < 150,000/uL (150 x 10^9/L)

o Prolonged bleeding: < 50,000/uL (50 x 10^9/L)

o Spontaneous, life-threatening hemorrhages: < 20,000/uL (20 x 10^9/L)

o Platelet transfusion indication = < 10,000/uL (10 x 10^9/L) unless actively bleeding

2. Peripheral blood smear: to distinguish between ITP and TTP from congenital disorders

3. Prothrombin time (PT) and activated partial thromboplastic time (aPTT) = may be normal with

thrombocytopenia; if they’re increased Disseminated intravascular coagulation

4. Bone Marrow exam = rules out production problems

Abigail Del Fierro

5. Assays: ITP antigen specific assay; 14C-serotonin release assay (ITP & HIT); enzyme-linked

immunosorbent assay (ELISA) for PF4-Heparin complexes (HIT); ADAMTS13 assay (TTP) isn’t

always a diagnostic Increased lactate dehydrogenase (LDH) may assist with diagnosis

Nursing Management (thrombocytopenia)

A> Subjective: past health history (illness, bleeds, cancer, HIV, anemia, cirrhosis, DIC, toxic chemicals or

radiation exposure); medications; fam hx

Objective: fever, lethargic; petechiae, ecchymoses, purpura; splenomegaly, abdominal distention,

guaiac-positive stool; decreased hgb/hct; normal/increased megakaryocytes (bone marrow)

D> Impaired oral mucosa r/t decreased platelet count and/or affects of pathologic conditions and

treatment; Risk for bleeding r/t decreased platelets; deficient knowledge r/t lack of knowledge regarding

disease process and treatment

P> Have no gross/occult bleeds, maintain vascular integrity, manage home care to prevent

complications r/t increased risk of bleeding

Interventions:

1. Health promotion discourage OTC use (aspirin); encourage medical evaluation when bleeding

tendency develops and to notify HCP; observe early sx of thrombocytopenia (patients on cancer

chemotherapy drugs)

2. Acute intervention: nosebleeds and new petechiae should be reported to HCP (may mean

hemorrhage); avoid IM injections; SubQ injection with small gauge and apply 5 – 10 minute

pressure afterwards or icepack; monitor blood cells and coagulation studies; count sanitary

napkins (if > 50 mL = completely soaked napkin = administer hormonal agents to decrease blood

loss); monitor platelets, hgb/hct, coagulation studies (for potential/active bleeding)

3. Ambulatory/home care: teach to avoid causative agents, injury/trauma; teach sx of bleeds d/t

thrombocytopenia; have planned periodic medical evaluations to assess bleeds

E> no evidence of bleeding/bruises and verbalized required knowledge, skill to manage disease process

at home.