Definition of Thrombocytopenia Disease:
Thrombocytopenia disease is a condition in which relatively platelet counts low in the blood. A normal human platelet count ranges from 150000 to 450000 micro liter of blood. Platelet is an important blood cell that helps to stop bleeding by clamping and forming plugs in blood vessel injuries. Thrombocytopenia disease happens when number of count falls under 150,000 micro liter.
Causes of Thrombocytopenia Disease:
The causes of thrombocytopenia disease can be inherited or caused by a number of medications or conditions.
1. Failure to production:
Low platelet count due to impaired production is generally due to problems with the bone marrow-
- Leukemia’s or Lymphomas,
- A plastic anemia or Myelodysplastic syndrome,
- Cirrhosis (Liver scaring),
- Vitamin B12 deficiency,
- Infection especially septicemia (Viral or Bacterial injects, Rubella, Mumps, Varicella, EBV),
- Heavy alcohol consumption,
- Chemotherapy or Cytotoxic drugs,
- Use of some medication: Chloramphenicol, Gold, Phenytoin (Dilantin), Valproic acid.
- Tumor invasion of bone marrow,
- Military tuberculosis.
2. Increased Destruction:
Due to antibiotics reasons-
- Idiopathic Thrombocytopenic Purpura (ITP),
- Thrombotic Thrombocytopenic Purpura (TTP),
- Disseminated Intravascular Coagulation (DIC),
- Systemic Lupus Erythematosus (SLE),
- Drug-induced nonimmune thrombocytopenia,
- Drug-induced immune thrombocytopenia,
- Hypersplenism (Swollen spleen),
- Dengue fever,
- Hemolytic- Uremic Syndrome( HUS),
- Post Transfusion purpura,
- HELLP Syndrome (Hemolysis, Elevated Liver Tests, Low Platelets),
- Paroxysmal Nocturnal Hemoglobinuria,
- Rheumatoid arthritis,
- Heart bypass surgery,
- Some Medications such as heparin, quinine, sulfa-containing antibiotics and anticonvulsants).
Sign and Symptoms of Thrombocytopenia Disease:
Various sign and symptoms of thrombocytopenia disease are mentioned in the following:
- Petechiac (Reddish purple spot rush under skin),
- Unexpected bruising (Purpura),
- Bleeding from the mouth, nose and gums,
- Excessive menstrual bleeding,
- Prolonged bleeding from cuts injury,
- Enlarged spleen,
- Blood in urine or blood,
- Bloody vomit,
- Hemorrhage or GI bleeding,
- Severe headache,
- Muscle and joint pain,
Test and Diagnosis of Thrombocytopenia Disease:
Various test and diagnosis systems of thrombocytopenia disease are mentioned in the below:
- Complete medical history,
- Blood test (CBC, PT, PTT, Peripheral blood smear, liver enzymes, kidney function, vitamin B12, folic acid levels),
- Physical examination,
- Bone marrow biopsy.
Treatment for Thrombocytopenia Disease:
Different treatments for thrombocytopenia disease are in the following:
- Corticosteroids -Try to increase platelet count,
- Intravenous immunoglobulin (IVIG) – Attempt to decrease the severity of auto immune disease and in acute infection.
- Rho D immune globulin (WinRho)- it is alternate to traditional IVIG
- Rituximab -used to treat lymphoma, Leukemia’s, Auto immune disorder after spleenectomy.
Spleenectomy – This surgery may be used if treatment with medicines doesn’t work. This surgery mostly is used for adults who have immune thrombocytopenia (ITP).
3. Blood or platelet transfusion:
To replace blood lost with transfusions of packed red blood cell or platelets.
4. Plasma Exchange:
This is an exchange transfusion involving removal of the patient’s blood plasma and replacement with donor plasma and used to treat Thrombotic Thrombocytopenic purpura (TTP).
Complications of Thrombocytopenia Disease:
When platelet count falls below 10000 platelets per micro liter severe brain or gastrointestinal bleeding occur.
Nursing Interventions for Thrombocytopenia Disease:
Various nursing intervention for thrombocytopenia disease are mentioned in the following:
- Assess the Patient for any sign symptoms of unusual bleeding, such as- Epistaxis, Hemoptysis, Gingival bleeding, Purpura.
- Monitor platelet and coagulation test results and report for any abnormal values.
- Avoid any intramuscular or subcutaneous injection.
- Use small gauge needle when performing venous or arterial punctures.
- Apply gentle prolonged pressure to venous and arterial or bone marrow aspiration site.
- Avoid any anti-coagulant drugs without any doctor’s approval.
- Avoid any per rectal medication (Suppository) enemas, vaginal douches.
- Avoid cutting nails, shaving with sharp blade.
- Provide semi solid or liquid diet.
- Encourage the Patient to take adequate fluid to avoid constipation.
- Use a soft bristle tooth brush and avoid dental floss.
- Do not strain to move bowels.
- Check BP only when necessary.
- Keep high fowlers position if epistaxis present and apply pressure and ice pack to nasal area.
- Instruct client to avoid nose blowing and keep hydrate nasal mucosa with nasal drop.
- Keep bed lower position with side rails up to prevent patient fall.
- Transfuse blood cells (Platelets, fresh frozen plasma or Packed Red Blood Cell) as ordered.
- Check any transfusion reaction and report it.
- Monitor intake output carefully to evaluate renal function.
- Administer medication like steroids, IVIG, Rituximab as ordered.
- Monitoring for side effects of the prescribed medications and their interactions with other drugs.
- Encourage patient to give up alcoholism because these can worse bleeding problem.
- Instruct patient to Avoid contact sports and other activities that might cause injury.
- Instruct patient to avoid contact with toxic chemicals. Chemicals such as pesticides, arsenic, and benzene can slow the production of platelets.
- Avoid medicines that you know have decreased your platelet count in the past.
- Instruct patient to avoid some medications that increase bleeding tendency such as aspirin, ibuprofen.
- Arrange and vaccinated patient against some disease such as mumps, measles, rubella and chickenpox.
- Provide good oral care (using oral swabs, a normal saline rinse, or other mouthwash as appropriate) helps to keep mucous membranes moist and minimize bleeding.
- Instruct the patient to do not walk in bare fee.
- Instruct the patient to avoid wear tight clothing.
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- Thrombocytopenia: Symptoms and Low Platelet Count.
- Thrombocytopenia (ITP, TTP) – Blood Disorders.
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- Thrombocytopenia Definition.
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