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ThrombocytopeniaGopal SinghAssist. Professor

Platelet PhysiologyPlatelets are produced by megakaryocytes in the bone marrow, and have an average lifespan of 9 to 10 days.Normal bone marrow contains 6 X 10(6) megakaryocytes per kilogram body weight

Platelet PhysiologyEach megakaryocyte release up to 1000 plateletsThe normal daily rate of platelet production is equivalent to about 35,000 4,300 platelets per microliter of blood, to maintain steady levels of about 250,000 100,000

ThrombocytopeniaThrombocytopenia refers to decreased circulating platelets and an increased tendency to bleed.

Etiology/FactorsFactors RationaleAge (children)Thrombocytopenia is a disease of younger peopleGender (Women)The disease is seen as twice as often in women as in men.Blood losssevere blood loss could cause the circulating platelets to decrease in numberPregnancy (Preeclampsi)Thrombocytopenia is the most common hematologic complication of preeclampsia among pregnant women. The cause of thrombocytopenia has been ascribed to platelet deposition at the site of endothelial injuryHematologic malignancy such as leukemiaAnemia (Aplastic and Pernicious)Radiation therapyDrug therapy (thiazides, chemotherapy agents, estrogens)HIV infectionImmature WBC crowd out normal bone marrow cells thus platelet production decreasesBone marrow does not produce enough plateletsBone marrow activity is suppressedBone marrow aplasia or hypoplasia occursAn infection with HIV suppresses the production of megakaryocytes, the platelet precursorsEtiology/Factors..Factors RationaleIncreased platelet destruction outside the bone marrowDrug therapy (antibiotics, sulfonamides, gold salts)Idiopathic causesBlood transfusionsDisseminated intravascular coagulationAntibodies form and attack platelets Clotting factors are consumed including plateletsAbnormal distribution of plateletsSplenomegalyPlatelets collect in spleen; circulating platelets decreases7Clinical featuresBleedingMalaiseGeneral weaknesFatiguePetechiae (less than 3mm)Ecchymoses (purple than 1 cm is) Larged blood-filled bullae in the mouthMelenaHematuriaOther

less than 3mm8Investigation CBCBMAAPTT (between 25 to 35 seconds)PT (11 to 13.5 seconds)Platelet associated antibodies

Nursing DiagnosesRisk for injury related to bleeding tendencyRisk for infection related to inadequate secondary defencesHigh risk for fluid volume deficit related to hemorrhageAltered tissue perfusion (peripheral) related to hypovolemiaHigh risk for trauma related to abnormal blood profileAcute pain related to hemorrhage

Nursing ManagementMonitor for changes in vital signs such as increase in PR, RR, and decrease in BP.Assess/ Monitor for signs of bleeding: epistaxis, bleeding of gums, rectum.Monitor for systemic signs of bleeding and hypovolemia.Instruct patient to avoid contact sports.Avoid invasive procedures including rectal temperature taking.Use soft- bristled toothbrush.Avoid NSAIDs (e.g. aspirin) for these are sulfa-containing meds that alter platelet function and increase bleeding tendencies.Nursing ManagementAdvise patient to avoid flossing.Fluid replacement for rapid loss of blood.Administer blood transfusion cryoprecipitate Fresh Frozen PlasmaMonitor for changes in neurological status (e.g. headache, confusion, visual disturbances).Apply direct pressure for 5-10 minutes then a pressure dressing.Treat nausea aggressively to prevent vomiting as severe nausea causes GI bleeding.

POLYCYTHEMIA

PolycythemiaAbnormal increase in blood cells

Types of Polycythemia Polycythemia Rubra veraRapid increase of marrow stem cell production of RBCs

production of WBC

production of platelets

It is usually associated with in HB in hematocrit in red cell count

PathophysiologyClinical FeaturesRed coloration, especially of the face (Plethora)DizzinessHeadacheSymptoms caused by splenomegally (75%)ThrombosisHypertention (20-50%)Vision problems

DiagnosisBlood PictureRBCsHBHtPlatelets usually WBCs

DiagnosisBone Marrow AspirationHyperactivity of all blood elements with megakaryocytes Serum Uric acid E.S.RErythropoietin

ComplicationsMyelosclerosisMyeloid leukemiaVascular thrombosisHaemorrhage Myelosclerosis=build-up of fibrous connective tissue in the bone marrow22Secondary polycythemiaExcessive production of RBCs because ofHypoxemiaTumoroverproduction of erythropoietinShortness of breath from underlying pulmonary disease, symptoms from underlying disease processesClinical featuresRuddy cyanosisEcchymosisSpoon-shaped nailsClubbing of fingers

Mucosal congestion combined with cyanosis.25Nursing InterventionBleeding precautionsFluid managementMedication managementTeaching: Disease processEnvironmental managementWound careNursing InterventionPeriodic phlebotomiesBone marrow suppression Treat underlying causeDiet Therapy Low-cholesterollow-fat low-sodium dietlow-purine dietThank You