DISEASE SPECIFIC INFORMATION DISEASE/DEFINITION Thrombocytopenia- a reduction of platelets below 150,000/uL PATHOPHYSIOLOGY Thrombocytopenia can result from decreased

production of platelets within the bone marrow or from increased destruction or consumption of platelets. Causes include: failure of production as a result of certain anemias, septicemia, and cytotoxic medications. Platelet disorders can be inherited (e.g., Wiskott-Aldrich syndrome), but the vast majority are acquired. A common cause of acquired disorders is the ingestion of certain foods, herbs, or drugs. CLINICAL MANIFESTATIONS (SIGNS AND SYMPTOMS) with platelet count below 50,000: bleeding and petechiae - With platelet count below 20,000: nosebleeds, gingival bleeding, excessive menstrual bleeding, and hemorrhage after surgery or dental extractions - With platelet count below 5,000: spontaneous fatal central nervous system hemorrhage or gastrointestinal hemorrhage COMPLICATIONS Hemorrhage- may be insidious or acute, severe anemia, confusion or other neurologic changes, and severe bleeding in the brain or intestines, which can be fatal COMMON TREATMENT Corticosteroids (e.g., prednisone) are used to initially treat ITP to block the antibodies that attack platelets. - Splenectomy may be indicated if patient does not respond to prednisone initially or requires unacceptably high doses to maintain an adequate platelet count. - Blood transfusions to increase platelet counts in cases of life-threatening hemorrhage and replace lost blood with transfusions of packed red blood cells or platelets. DIAGNOSTICS History and physical examination - Specific studies: Hb, LDH, reticulocytes, Haptoglobin - Bone marrow aspiration and biopsy - Coagulopathy: PT, aPTT, D-dimer - CBC including platelet count TEACHING NEEDS Notify HCP of any manifestations of bleeding: black, tarry stools, bruising, bleeding from mouth, difficulty talking, etc. - Do not blow your nose forcefully; gently pat it with a tissue. - Do not bend down with your head lower than your waist. - Shave only with an electric razor. - Use a soft-bristle toothbrush. COMMON NURSING INTERVENTIONS Assist the patient to select soft, bland, and nonacidic foods to decrease irritation of oral mucosa. - Encourage to use a soft toothbrush for removal of dental debris. - Monitor for S&S of persistent bleeding (e.g., check all secretions for frank or occult blood). - Monitor coagulation studies (PT, aPTT, fibrinogen, and platelet counts) to determine bleeding risk. - Administer blood products (e.g., platelets, fresh frozen plasma) to replace coagulation factors). REFERENCE: PAGE NUMBER FOR LEWIS. FULL TITLE, AUTHOR, AND PAGE NUMBER FOR OTHER SOURCES Medical-Surgical Lewis Pages 678 684