THROMBOCYTOPENIA

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THROMBOCYTOPENIA

• - reduced platelet count -

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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.

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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.

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Causes.
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Lets take a look at Thrombocytopenia purpura . .

• Immune thrombocytopenic purpura (ITP)
• In ITP platelets are coated with antibodies.
• Spleen doesnt recognize them and macrophages
  destroy them.

• Most common cause of increased destruction of
  platelets.
• May be immune or drug induced.

• 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  2 weeks after medication is withdrawn..

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Clinical Manifestations.

• Most common observable signs
• Petechiae
• Capillary hemorrhage
• Eccymoses
• Bruising

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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.

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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.

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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).

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Medical Management.

• Corticosteroid therapy.
• these have the ability to suppress the
  phagocytic response of splenic macrophages.

• Splenectomy.
• removes the spleen in order to stop the splenic
  macrophages from destroying platelets.

• Intravenous immunoglobulin / immunosuppresive
  drugs.
• blocks antibody receptors in the macrophages.

• Tranfusions with platelet concentrates.

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Nursing Interventions.

• Prevent infection and trauma by practicing
  meticulous asepsis and gentle handling of
  patients.
• Check patients urine, stool and emesis for
  blood.

• Monitor potential sites for hemorrhage.
• Maintain comfort measures and bed rest.
• Always monitor vital signs.

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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

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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.