Thrombocytopenia: Causes, Symptoms, Diagnosis, Treatment, Complications, Nursing Intervention by Nurses Note

 Thrombocytopenia

Thrombocytopenia is characterized by a decreased platelet count (less than 150,000/mm3), the most common cause of bleeding disorders.

Pathophysiology and Causes of Thrombocytopenia

Classification by Causes 

 1. Decreased platelet production—infiltrative diseases of bone marrow, leukaemia, aplastic anaemia, myelofibrosis, myelosuppressive therapy, radiation therapy; may include inherited disorders, such as Fanconi’s anaemia and Wiskott-Aldrich syndrome.

 2. Increased platelet destruction—infection (eg, HIV or hepatitis C), drug-induced (eg, heparin or quinidine), ITP, DIC.

 3. Abnormal distribution or sequestration in spleen.

 4. Dilutional thrombocytopenia—after hemorrhage, RBC transfusions.

Clinical Manifestations of Thrombocytopenia

 1. Usually asymptomatic.

 2. When platelet count drops below 20,000/mm3:

       a. Petechiae occur spontaneously.

       b. Ecchymoses occur at sites of minor trauma (venipuncture, pressure).

       c. Bleeding may occur from mucosal surfaces, nose, GI and GU tracts, respiratory system, and within CNS.

       d. Menorrhagia is common.

 3. Excessive bleeding may occur after procedures (dental extractions, minor surgery, biopsies).

 4. Thrombotic complications (arterial and venous) and areas of skin necrosis are associated with heparin-induced thrombocytopenia.

Diagnostic Evaluation of Thrombocytopenia

 1. CBC with platelet count—decreased haemoglobin, hematocrit, platelets.

 2. Bleeding time, prothrombin time (PT), partial thromboplastin time (PTT)—prolonged.

 3. Platelet aggregation test for heparin-dependent platelet antibodies—positive.

Management of Thrombocytopenia

 1. Treat the underlying cause.

 2. Platelet transfusions.

 3. Steroids or IV immunoglobulins may be helpful in selected patients.

 4. Heparin-induced thrombocytopenia: discontinue heparin, use alternate anticoagulant therapy due to high risk of venous and arterial thromboses in these patients (direct thrombin inhibitors, such as lepirudin or argatroban hirudin), avoid platelet transfusions. Although incidence varies dependent upon patient population and heparin preparation, any exposure to heparin can precipitate this serious autoimmune syndrome.

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Complications of Thrombocytopenia

Severe blood loss or bleeding into vital organs may be life-threatening.

Nursing Assessment of Thrombocytopenia

 1. Obtain health history, focusing on prior illnesses and episodes of bleeding, past surgical experiences, exposure to toxin bleeding ionizing radiation, family history of bleeding.

2. Obtain list of current and recent medications (including OTC preparations, herbal and dietary supplements).

 3. Perform complete physical examination for signs of bleeding.

Nursing Diagnosis of Thrombocytopenia

 Risk for Injury related to bleeding due to thrombocytopenia.

Nursing Interventions of Thrombocytopenia

Minimizing Bleeding

 1. Institute bleeding precautions.

a. Avoid use of plain razor, hard toothbrush or floss, I.M. injections, tourniquets, rectal procedures, suppositories.

b. Administer stool softeners, as necessary, to prevent constipation.

c. Restrict activity and exercise when the platelet count is less than 20,000/mm3 or when active bleeding occurs.

 2. Monitor pad count and amount of saturation during menses; administer or teach self-administration of hormones to suppress menstruation, as prescribed.

 3. Administer blood products, as ordered. Monitor for signs and symptoms of allergic reactions, anaphylaxis, and volume overload.

 4. Evaluate urine, stools, and emesis for gross and occult blood.

Patient Education and Health Maintenance

 1. Teach patient bleeding precaution

 2. Demonstrate the use of direct, steady pressure at the bleeding site if bleeding develops.

 3. Encourage routine follow-up for platelet counts.