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Thrombocytopenia

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Pathophysiology: This can occur for either unknown reasons or autoimmune. Platelets are destroyed by the body (autoimmune) or are decreased for unknown reasons.

Overview
  1. Decrease in circulating platelets (<100,000/mL)
    1. Often far less before treatment  (<40,000/mL)

Nursing Points

General

  1. Causes
    1. Decreased production
      1. Aplastic Anemia
    2. Increased destruction
      1. Autoimmune Disorders
    3. Medication induced
      1. Heparin-Induced

Assessment

  1. Abnormal Labs
    1. ↓ Platelet count
    2. ↓ Hgb, Hct
    3. Monitor CBC
  2. Bleeding
    1. Petechiae
    2. Epistaxis
    3. GI bleeding
      1. Hematemesis
      2. Melena
      3. Occult blood in stool
    4. Hematuria
    5. Hemoptysis

Therapeutic Management

  1. Platelet transfusions
  2. Bleeding precautions
    1. Avoid invasive procedures
    2. Soft bristled toothbrush
    3. Avoid medications that interfere with coagulation (i.e. Aspirin, Heparin)
  3. Diagnosis made via bone marrow aspiration

Nursing Concepts

  1. Clotting
    1. Monitor for signs of bleeding
    2. Educate patient on bleeding precautions
    3. NO invasive procedures unless medically necessary
      1. IV starts, NG Tube, Foley
      2. Central Lines
    4. Assess all current lines for bleeding

Patient Education

  1. Bleeding precautions
    1. No straight blade razors – electric only
    2. Soft-bristle toothbrush
    3. Report bleeding to provider
    4. Avoid injury/falls
  2. Do NOT take Aspirin or other anticoagulants without permission from primary care provider
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Nursing Care Plan for Thrombocytopenia

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Video Transcript

Okay, guys, in this lesson we’re going to review nursing implications of thrombocytopenia. Let’s break down this word. Thrombocyte is another word for platelets. And any time you see -penia you should think lack of or too little.

So, Thrombocytopenia is a lack of platelets – by definition it’s platelets less than 100,000, but usually we see much lower than that, like less than 40,000. There are a couple of general causes – either decreased production, increased destruction, or medication induced. An example of decreased production would be like in aplastic anemia where the bone marrow stops producing blood cells altogether. Increased destruction can happen in some autoimmune diseases like lupus, and medications like heparin can induce a severe thrombocytopenia in patients.

So we’ll see decreased platelet counts. Like I said, less than 100,000, but usually we don’t start treating until less than 40,000 or so. Now, we know that platelets are responsible for the clotting process, right? So if we have too few platelets in our system, we’re going to see bleeding. This isn’t usually AS severe as something like DIC, but they will ooze from all their IV sites, and will probably have petechiae or purpura on their skin like you see here. They could have epistaxis or nosebleeds. GI bleeding could cause hematemesis, melena, or occult blood in the stool. They could even have hematuria or blood in their urine or hemoptysis which is coughing up blood. Anything that would normally cause bleeding will simply cause more bleeding than usual because of the low platelets.

We could possibly do a bone marrow aspiration from one of the major flat bones to confirm diagnosis of what’s causing the thrombocytopenia, but usually our lab values are enough. When their platelets are low enough, we’ll give them platelet transfusions. Key thing to note here is that platelets have to be blood type compatible just like red blood cells, so make sure you’re checking the blood compatibility chart. We will also avoid any antiplatelet meds like aspirin or whatever med that caused the thrombocytopenia in the first place. If they do get heparin-induced thrombocytopenia, we consider that an allergy to heparin and that patient should not receive heparin ever again. And then, we want to put the patient on bleeding precautions. This means no straight blade razors – only electric razors. We use soft-bristle toothbrushes only. We want to monitor for any kind of bleeding and avoid falls or injury as much as possible. It’s possible for a patient to go home with thrombocytopenia, so make sure the patient understands these precautions as well.

The top priority nursing concept for a patient with thrombocytopenia is clotting. I know that seems obvious, but it’s important that we monitor for bleeding, monitor lab values, transfuse platelets, and institute bleeding precautions.

So, let’s recap. Thrombocytopenia is decreased platelets, below 100,000. This means the patient will struggle to form a clot if needed. So we’ll see signs of bleeding like petechiae, nose bleeds, or blood from other places – remember any time you see hemat or hemo think blood – so hematuria, hematemesis, hemoptysis, or GI bleeding. We want to replenish their platelets with transfusions and by avoiding antiplatelet meds, and we institute bleeding precautions. We want to monitor for bleeding and make sure we educate our patients on what to do and what to report to their provider.

So that’s it for thrombocytopenia. Check out the rest of the resources in this lesson to learn more. Now, go out and be your best self today. And, as always, happy nursing!

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