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ThrombocytopeniaThrombocytopenia

By

Dr. Hanan Said Ali

ObjectivesObjectives Define thrombocytopenia. Mention aetiology of thrombocytopenia. Identify Pathophysiology. Enumerates clinical manifestations of

thrombocytopenia. Describe the treatment of

thrombocytopenia. Explain nursing care for clients with

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ThrombocytopeniaThrombocytopenia Definition

It is defined as a lower than normal number of circulating platelets(Ranges of 150,000 to 400,000)

Aetiology Platelet disorders can be inherited, but vast

majority are acquired.

Many abnormalities occur following ingestions of some foods and drugs.

Thrombocytopenia ContThrombocytopenia Cont Aetiology Cont.

1. Decreased platelet production.

a. Inherited Fanconi’s syndrom(pancytopoenia). Hereditary thrombocytopenia

b. Acquired A plastic anaemia. Hematologic malignant disorder. Chronic alcoholism. Exposure to ionizing radiation

Thrombocytopenia ContThrombocytopenia Cont

Aetiology Cont. Viral infection. Deficiencies of folic acid.

2. Increased platelet destruction.

a. Non immune. Thrombotic thrombocytopenia purpura Pregnancy Infection Drug induced. Sever burns.

Thrombocytopenia ContThrombocytopenia Cont

Aetiology Cont.

b. Immune Immune thrombocytopenic purpura Human immunodeficiency virus infection. Drug induced.

c. Splenomegaly.

3. Drugs, spices and vitamin causing abnormalities in platelet function.

a. Suppression of platelet production. Thiazide diuretics, alcohol, oestrogen ,

chemotherapeutic drugs.

Thrombocytopenia ContThrombocytopenia Cont

Aetiology Cont.

b. Abnormal platelet aggregation NOAIDS (indomethacin) Antibiotic ( Penicillin and cephalosporin's) Analgesics (Aspirin) Spices (Ginger, cumin, garlic) Vitamins (vitamin C and E) Heparin Other drugs, digitoxin, oral hypoglycaemic

Thrombocytopenia ContThrombocytopenia Cont

Pathophysiology The major signs of thrombocytopenia

observable by physical examination are petechiae, ecchymosed, and purpura.

Petechae occurs only in platelet disorders.

The person may give a history of menorrhagia, epistaxis and gingival bleeding.

Thrombocytopenia ContThrombocytopenia Cont

Clinical Manifestation Appearance of small, flat, pin- point red or

reddish brown microphages “petechiae” When petechiae are numerous, the

resulting reddish skin bruise is termed “ Purpura”

Larger purplish lesions caused by haemorrhage are termed “ ecchymoses”

Ecchymoses may be flat or raised , pain and

Tenderness are sometimes present.

Thrombocytopenia ContThrombocytopenia Cont

Clinical Manifestation Cont. Prolonged bleeding often routine

procedures such as venipuncture or IM injection.

Weakness, fainting, dizziness, tachycardia, abdominal pain, and hypertension.

Complication Haemorrhage may be insidious or acute

and internal or external, it may occurs in:

joint, retina, and brain cerebral haemorrhage may be fatal.

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Thrombocytopenia ContThrombocytopenia Cont

Management

DiagnosisComplete laboratory studies.

Bone marrow examination (precursor of platelets in the bone marrow), and other abnormalities such as neoplastic invasion, a plastic anaemia or fibrosis.

Thrombocytopenia ContThrombocytopenia Cont

Treatment1. Immune thrombocytopenic purpura(ITP) Corticosteroids. Platelet transfusion. Intravenous immunoglobulin. Immunosuppressive. Spleenoectomy.

2. Thrombotic, thrombocytopenic purpura. Plasma infusion. Plasmapheresis and plasma exchange.

Thrombocytopenia ContThrombocytopenia Cont

Treatment Cont. High dose prednisone. Spleenoectomy.

3. Decreased production problems Identification and treatment of

cause. Corticosteroids. Platelet transfusion. Thrombopoietin (investigational)

Thrombocytopenia ContThrombocytopenia Cont

Nursing Intervention Assess bleeding sites and take measures.

(In women, count sanitary napkins used during menses e.g; fifty milli litres of blood will completely soak a sanitary napkin).

Proper administrations of platelet transfusion can increase platelet level.

(30 to 50 ml in volume can be derived by centrifuging 500 ml. Of whole blood).

Administration may be from mixed different donors or single twice weekly.

Thrombocytopenia ContThrombocytopenia Cont

Nursing Intervention Cont.

Assess the client for increased ecchymoses,

Petechiae, bleeding from other sites and any change in mental status.

Person with platelets counts below 20,ooo/mm

Should have bleeding precaution instituted :• Test all urine and stools for blood.• Do not administer intramuscular injections.• Apply pressure to all venipuncture sites for 5

minutes and for arterial for 10 minutes

Thrombocytopenia ContThrombocytopenia Cont

Nursing Intervention

The nurse should teach client about :

a) Nature of the disorder.

b) Signs of decreased platelets(petechaie, ecchymoses, gingival bleeding, hematuria, menorrhagia).

c) Name, dosage, frequency, and side effects, of medications. Corticosteroids not stopping abruptly.

Thrombocytopenia ContThrombocytopenia Cont

The nurse should teach client about :

Measures to prevent injury: Use a soft toothbrush or swab for mouth

care Do not use dental floss. Keep mouth clean and free of debris. Avoid intrusion into rectum(e.g. Rectal

medication and enemas). Use electric shaver.

Thrombocytopenia ContThrombocytopenia Cont

The nurse should teach client about :

Measures to prevent injury: Avoid contact sport, surgery and tooth

extraction. Avoid blood thinning drugs such as

Aspirin, that decreases sticking ability of platelet.

Increase knowledge of contents of over-the-counter(OTC) medications and effects on platelets functioning. Read labels on OTC drugs.

Thank You

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