1. THROMBOCYTOPENIA - reduced platelet count -

2. 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.

3. 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.

4. What can cause Thrombocytopenia? Decreased production of platelets. Aplastic Anemia. Leukemia. Tumors. Chemotherapy. Decreased platelet survival. Antibody destruction. Infection. Viral invasion. Increased platelet destruction. Diseminated intravascular coagulation. (DIC) Thrombocytopneic purpura. Causes.

5. Let’s take a look at Thrombocytopenia purpura..  Immune thrombocytopenic purpura (ITP) – In ITP platelets are coated with antibodies. Spleen doesn’t 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 Patients platelet count will return to normal 1 – 2 weeks after medication is withdrawn..

6. Clinical Manifestations. Most common observable signs:  Petechiae Capillary hemorrhage  Eccymoses Bruising

7. 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.

8. 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.

9. 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).

10. 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.

11. Nursing Interventions. Prevent infection and trauma by practicing meticulous asepsis and gentle handling of patients. Check patient’s urine, stool and emesis for blood. Monitor potential sites for hemorrhage. Maintain comfort measures and bed rest. Always monitor vital signs.

12. 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

13. 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.