1. C-Slide 1 Thrombocytopenia By Dr. Hanan Said Ali

2. Objectives  Define thrombocytopenia.  Mention aetiology of thrombocytopenia.  Identify Pathophysiology.  Enumerates clinical manifestations of thrombocytopenia.  Describe the treatment of thrombocytopenia.  Explain nursing care for clients with thrombocytopenia. C-Slide 2

3. Thrombocytopenia n 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.

4. Thrombocytopenia Cont n 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

5. Thrombocytopenia 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.

6. Thrombocytopenia 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.

7. Thrombocytopenia 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

8. Thrombocytopenia Cont n 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.

9. Thrombocytopenia 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.

10. Thrombocytopenia 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. C-Slide 41

11. Thrombocytopenia Cont Management Diagnosis Complete laboratory studies. Bone marrow examination (precursor of platelets in the bone marrow), and other abnormalities such as neoplastic invasion, a plastic anaemia or fibrosis.

12. Thrombocytopenia Cont Treatment 1. Immune thrombocytopenic purpura(ITP)  Corticosteroids.  Platelet transfusion.  Intravenous immunoglobulin.  Immunosuppressive.  Spleenoectomy. 2. Thrombotic, thrombocytopenic purpura.  Plasma infusion.  Plasmapheresis and plasma exchange.

13. Thrombocytopenia Cont Treatment Cont.  High dose prednisone.  Spleenoectomy. 3. Decreased production problems  Identification and treatment of cause.  Corticosteroids.  Platelet transfusion.  Thrombopoietin (investigational)

14. Thrombocytopenia 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.

15. Thrombocytopenia 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

16. Thrombocytopenia 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.

17. Thrombocytopenia 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.

18. Thrombocytopenia 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.

19. n Thank You C-Slide 50