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Thrombocytopenia

Thrombocytopenia. Objective. The learner will be able to define thrombocytopenia and identify three important signs and symptoms. Thrombocytes (Platelets). The life span of a platelet is 8-10 days Normal platelet count is 150,000-400,000/mm

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Thrombocytopenia

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  1. Thrombocytopenia

  2. Objective The learner will be able to define thrombocytopenia and identify three important signs and symptoms.

  3. Thrombocytes (Platelets) • The life span of a platelet is 8-10 days • Normal platelet count is 150,000-400,000/mm • Platelets are needed to produce a stable blood clot in response to vascular injury • Platelets are usually stored in the spleen and liver for quick release with bleeding • Platelet production requires protein, iron and other substances

  4. Thrombocytopenia • When the platelet count is < 100,000/mm. • More frequent in hematologic malignancies than in solid tumors • The nadir for a platelet count following cytotoxic therapy usually occurs between 7-14 days

  5. Thrombocytopenia in Cancer • Thrombocytopenia primary cause of bleeding in patients with cancer • Commonly attributed to myelosuppressive chemotherapy and/or radiation therapy • Bone marrow infiltration of the malignancy • Other causes of thrombocytopenia • Splenic sequestration of platelets • Immune-mediated thrombocytopenia • Platelet destruction from disseminated intravascular coagulation (DIC)

  6. Risk Factors for Thrombocytopenia • Idiopathic thrombocytopenic purpura or thrombotic thrombocytopenic purpura • Hypercoagulation disorders (e.g., paraneoplastic disorders, disseminated intravascular coagulation, thrombosis) • Hypocoagulation disorders (e.g., liver disease, vitamin K deficiency)

  7. Risk Factors for Thrombocytopenia • Chemotherapy (nadir usually 7-14 days, recovery within two to six weeks) • Radiation therapy • Endotoxins from bacteria during infection • Medications - aspirin, digoxin, furosemide, phenytoin, quinidine, sulfonamides, tetracycline

  8. Grades of Thrombocytopenia Platelet counts: • Grade 1: <75,000/mm3 • Grade 2: 50,000 - <75,000/mm3 • Grade 3: 10,000 - <50,000/mm3 • Grade 4: <10,000/mm3

  9. Complications of Thrombocytopenia • Defined as reduction in number of circulating platelets to < 100,000 • < 50,000 moderate risk of bleeding with minor trauma • <20,000 severe risk, increased risk of spontaneous bleeding • < 10,000 severe hemorrhage • Complications • Fatal intracranial bleed • Massive gastrointestinal bleed • Pulmonary hemorrhage

  10. Signs and Symptoms of Thrombocytopenia • Bleeding is manifested in several ways • Ecchymosis (bruising) • Petechiae can be presenting signs – itchless rash • Bleeding - epistaxis, hemoptysis, hematemesis, melena, hematuria, vaginal bleeding, and • Prolonged bleeding or oozing around wounds and vascular access lines

  11. Evidenced Based Interventions • Based on clinical symptoms and individual patient factors. • Many cases of mild thrombocytopenia resolve on their own and do not require treatment • Platelet transfusions generally are administered for a platelet count of < 10,000 or in the presence of bleeding. • Steroids may be used for drug-induced or disease-related thrombocytopenia • Progestational agents may be prescribed to decrease menstrual bleeding (Damron, et al., 2009)

  12. Thrombocytopenic Precautions • Avoiding use of a blood pressure cuff or tourniquet if the platelet count is < 20,000 • Avoiding invasive procedures • Teaching patients to avoid sharp objects and going barefoot • Applying firm pressure to venipuncture sites for five minutes • Treating nosebleeds with high Fowler's position, pressure to nose, and ice packs

  13. Thrombocytopenic Precautions • Instructing patient to follow a bowel regimen to prevent constipation • Using soft toothbrushes • Avoiding physical activity that can lead to trauma. • Avoid medications that can affect coagulation factors and increase bleeding risks • Teach patients to use electric razors for shaving • Avoid unnecessary venipunctures

  14. References Povolich, M., Whitford, J.M. & Olsen, M. (Eds.). (2009). Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Pittsburgh, PA; Oncology Nursing Society. Damron, B.H., Brant, J.M., Belansky, H.B., Friend, P.J., Samsonow, S., & Schaal, A. (2009). Putting evidence into practice: Prevention and management of bleeding in patients with cancer. Clinical Journal of Oncology Nursing, 13(5), 573-583.

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