7/27/2019 Thrombocytopenia.docx

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DISEASE SPECIFIC INFORMATION

DISEASE/DEFINITIONThrombocytopenia- a reduction of platelets below 150,000/uL

PATHOPHYSIOLOGY

Thrombocytopenia can result from decreased production of platelets within the bone marrow or from increased destruction or consumption of platelets. Causes include: failure of production as a result of certain anemia’s, septicemia, and cytotoxic medications. Platelet disorders can beinherited (e.g., Wiskott-Aldrich syndrome), but the vast majority are acquired. A common cause of acquired disorders is the ingestion of certainfoods, herbs, or drugs.

CLINICAL MANIFESTATIONS (SIGNS AND SYMPTOMS)  – with platelet count below 50,000: bleeding and petechiae- With platelet count below 20,000: nosebleeds, gingival bleeding, excessive menstrual bleeding, and hemorrhage after surgery or dentalextractions- With platelet count below 5,000: spontaneous fatal central nervous system hemorrhage or gastrointestinal hemorrhage

COMPLICATIONSHemorrhage- may be insidious or acute, severe anemia, confusion or other neurologic changes, and severe bleeding in the brain or intestines,

which can be fatal

COMMON TREATMENT  – Corticosteroids (e.g., prednisone) are used to initially treat ITP to block the antibodies that attack platelets.- Splenectomy may be indicated if patient does not respond to prednisone initially or requires unacceptably high doses to maintain an adequateplatelet count.- Blood transfusions to increase platelet counts in cases of life-threatening hemorrhage and replace lost blood with transfusions of packed red blood cells or platelets.

DIAGNOSTICS  – History and physical examination - Specific studies: Hb, LDH, reticulocytes, Haptoglobin- Bone marrow aspiration and biopsy - Coagulopathy: PT, aPTT, D-dimer - CBC including platelet countTEACHING NEEDS  – Notify HCP of any manifestations of bleeding: black, tarry stools, bruising, bleeding from mouth, difficulty talking, etc.- Do not blow your nose forcefully; gently pat it with a tissue.

- Do not bend down with your head lower than your waist.- Shave only with an electric razor.- Use a soft-bristle toothbrush.

COMMON NURSING INTERVENTIONS  – Assist the patient to select soft, bland, and nonacidic foods to decrease irritation of oral mucosa. - Encourage to use a soft toothbrush for removal of dental debris.- Monitor for S&S of persistent bleeding (e.g., check all secretions for frank or occult blood).- Monitor coagulation studies (PT, aPTT, fibrinogen, and platelet counts) to determine bleeding risk.- Administer blood products (e.g., platelets, fresh frozen plasma) to replace coagulation factors).

REFERENCE: PAGE NUMBER FOR LEWIS. FULL TITLE, AUTHOR, AND PAGE NUMBER FOR OTHER SOURCESMedical-Surgical Lewis Pages 678  – 684