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03.05 Platelets

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Overview

  1. Platelets
    1. Normal Value Range
    2. Pathophysiology
    3. Special considerations
    4. Elevated platelet levels
    5. Decreased platelet levels

Nursing Points

General

  1. Normal value ranges
    1. 100,000 – 450,000/mcL
    2. Also known as – Thrombocytes
  2. Pathophysiology
    1. Formed from Megakaryocyte
      1. Formed from bone marrow
      2. Produces 1000-3000 platelets
    2. Injury occurs at site
      1. Collagen releases activators
      2. Thrombocytes activate “sticky fingers”, which allow them to bind together.
      3. Travel to site (along with other clotting factors)
      4. Adhere to site, increase stimulation for other PLT, until clot is formed with fibrin
  3. Special considerations
    1. Use a lavender top tube (EDTA)
    2. Often sent in CBC
  4. Abnormal lab values
    1. Elevated platelets (thrombocytosis)
      1. Cancers
      2. Absence of a spleen
        1. Breaks down platelets
      3. Birth control
      4. Polycythemia vera
        1. Overproduction of cells
        2. Treatment via bloodletting, medications or hydration
    2. Decreased platelets (thrombocytopenia)
      1. ITP (Idiopathic thrombocytopenic purpura)
        1. Autoimmune disease
        2. Medications
      2. Hemorrhage
        1. Treated with transfusion
      3. Leukemia
        1. Treated with chemotherapy/radiation
      4. Medications
        1. Some diuretics
        2. Nonsteroidal anti-inflammatory drugs (NSAIDs)
        3. Ranitidine
        4. Some antibiotics

Assessment

  1. Assess for signs of petechia (small purplish blemishes, indicating bleeding)

Therapeutic Management

  1. Control and stop hemorrhage
    1. Replace platelets via transfusion
  2. Consider stopping or changing medications that cause thrombocytopenia

Nursing Concepts

  1. Lab Values
  2. Clotting

Patient Education

  1. For patients who have bleeding disorders, instruct patients to be cautious of injury.
  2. If patient has thrombocytopenia, instruct patient to seek emergency treatment in the event of bleeding that does not stop.

**DISCLAIMER – The video states that the normal value of platelets is 100,000 – 400,000 cells/mcL. The correct information is 100,000 – 450,000 cells/mcL.

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Video Transcript

In this lesson we’re going to talk about platelets and how they play a role in your patient’s ability to clot.

The normal values for platelets are going to be a hundred thousand to 400,000 cells per microliter. Anything less than a hundred thousand cells per microliter is considered to be a condition called thrombocytopenia. Platelets are also called thrombocytes, so that’s where we get the word from beside of penia meaning low platelets.

In this picture you can see that the thrombocyte, this yellow cell is much smaller than red blood cells or white blood cells.

Let’s look at how platelets work.

Platelets are formed from the cells called megakaryocytes, and they’re these really large cells, and they break off all of the little platelets. I’m megakaryocytes can actually produce anywhere from 1000 to 3000 platelets during its lifetime. These are all derived from the bone marrow.

Now the way platelets work is that you’ll have an injury at a particular site, so maybe a laceration. What happens is the collagen in the skin triggers a reaction that stimulates platelets to come to the site. Normally platelets are these little round flat cells, and when they’re triggered they actually activate and create these little finger-like projections. Think of them as like sticky fingers. That makes them more likely to stick to whatever site they’re going to. The entire clotting Cascade is very very complicated, and there are a lot of other factors that play into it, but what you need to know is that the platelets arrive to the site and stick to the injury, and that triggers more of an active response and it brings in all these other platelets and as you can see in this picture, the platelets all start to form this little clot. The platelets will also interact with fibrin to create a clot at the site and that’s what stops the bleeding.

So what do you need to be considerate of whenever you’re drawing a sample? Just know that you’re platelet samples are going to be submitted in a lavender top tube, that has the EDTA in it. It’s often submitted with the CBC, and that helps to give a general overview of all the cells in your patient. So you also get results that’ll include things like yours white blood cells, red blood cells, hematocrit and hemoglobin.

The next question you probably have is what do high and low values of platelets indicate?

With elevated platelets, a condition known as thrombocytosis, is when the platelets are greater than 400000 cells per microliter. Conditions that will trigger this are things like cancers or malignancy. Another situation is the absence of a spleen. The spleen’s responsibility is to break down old or damaged platelets, and if there’s no spleen, that can’t occur and therefore your platelet values may go up. Certain types of birth control can also cause increase in platelets, and also the condition that we talked about in some other lessons called polycythemia vera. Polycythemia vera is in uncommon type of bone marrow cancer causes this massive overproduction of cells. These will include white blood cells, red blood cells and platelets. Treatment is typically bloodletting, or the actual removal of blood from a patient through phlebotomy to decrease the overall blood volume. The blood becomes really thick and viscous when there’s as overproduction of cells, and that’s how they treated. It can also be treated through making sure the patient is adequately hydrated, and some medications can help this condition.

If a platelet values are low it’s a condition called thrombocytopenia. There are a couple of specific conditions, one called ITP. This is idiopathic thrombocytopenia purpura, and what it is is it’s an autoimmune disease that attacks antibodies on the platelets and destroys them. If you don’t have platelets, you can’t clot, so these patients are at a much higher risk of clotting. Patients that have ITP will go through some sort of medication therapy that suppresses the immune system so that it doesn’t attack itself. These patients are definite risk for bleeding, and sometimes they’ll develop these little areas of bleeding underneath the skin called petechiae. Sometimes they look like little bleeding stars. So if you see that, you might want to suspect a platelet issue with your patient. Another condition that you’re going to see decreased platelets in is hemorrhage and you’re going to treat those patients with platelet transfusions. Patients that are undergoing chemotherapy or radiation for leukemia they also have decreased platelets. And another thing to consider is medications. Certain medications can have the potential to decrease platelet production. These are things like diuretics, NSAIDs, Ranitidine, and certain types of antibiotics. So be sure to review any medications if you’re suspicious of some sort of clotting issue for your patient.

Nursing concepts for this lesson include a lot of values and clotting, because that’s what the responsibilities of the platelets are.
So let’s recap.

The normal values for platelets are 100,000 to 400000 cells per microliter.

The responsibility of the platelet is for clotting.

If you have increased platelets, that could be from cancers, polycythemia vera, or over production. Also consider if the patient has had a splenectomy.

Decrease platelets are on much more concerning, so consider things like ITP, leukemia, or Hemorrhage.

If your patient does have decreased the values of platelets, or are at risk for having decrease platelets, make sure that they understand that they are always at risk for bleeding. Make sure that they know when to come to the emergency room if they have some sort of injury that won’t stop bleeding, and make sure that you go over any medications that could potentially cause bleeding issues.

That’s it for our lesson on platelets. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

  • Question 1 of 4

The nurse is getting ready to administer platelets to a client. Which of the following considerations must the nurse take into account before platelet administration?

  • Question 2 of 4

A client presents to the ER after falling down the stairs and getting a cut on their knee that won’t stop bleeding. The nurse examines the client and notices tiny purple dots all over the client’s skin as well as little bruises all over in different stages of healing. Which of the following conditions does this client most likely have?

  • Question 3 of 4

Which of the following tests are used to measure a client’s platelet count?

  • Question 4 of 4

A client presents with both a heavy menstrual period and a nose bleed that has been going on for 5 hours. The nurse examines the client and notices tiny purple dots all over the client’s skin. Which of the following conditions is consistent with these symptoms?

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