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 anemia’s, 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,