Thrombocytopenia - Low platelet count.
nursebob

Thrombocytopenia
     Platelet count below 100,000.
     Platelet count below 50,000 increases the risk of hemorrhage.
     Plattelet count of 10,000 to 15,000 may cause spontanous bleeding.
     A platelet count below 10,000 can be fatal.
Early signs of thrombocytopenia.
Petechiae.
Purpura over several days
May have bleeding from mucosa.
Most common severe bleeding may be from the brain or GI track.
Occasionally may have pericardial bleeding or bleeding from the lungs.
     Hemmorrhagic disorders.
          Bloody urine
          Bleeding of the gums.
          Blood in stool.
          Bloody sputom.
          Multiple petechiae
          Scleral hemorrhage
          Ecchymosis.
False Thrombocytopenia.
Occasionally blood will react with EDTA an anticoagulant used in blood collection tubes.
This causes platelets to clump to gether and adhere to white blood cells causing a false low platelet count.

Additional Labs should be done.
CBC.
Bleeding time
Prothrombin time.
Activated partial thromboplastin time.
platelet antibody studies.
platelet survival studies
bone marrow biopsy.

Types of thrombocytopenia
The key types of thrombocytopenia are druginduced, idiopathic, and thrombotic.

Drug-induced thrombocytopenia.
    Immune reaction.
    Activated antibodies remove the platelets from circulation.
    Reduces platelets after starting a new drug.
  
    Platelets may clump together causing arterial or venous thrombosis.
    Drugs
       Most common cause is heparin.
       Sulfonamides
       Quinine
       Chemotherapy.
Usually discontinuing the drug takes care of the problem.
Radiation.

Idiopathic

Paletelets may have a shorter life span.
Splenomegaly
     Spleen contains 30% to 40% of platelets
     Accumulation of platelets in the spleen.

Idiopathic thrombocytopenia purpuva
     Autoimmune disorder.
     Formation of antiplatelet antibodies.
     Platelets more susceptible to phagocytosis and destruction in the spleen.

Thrombocytopenic purpuva
    Widespread thrombi in the arterioles and capillaries in the microcirculation.
    Caused by endothelial injury.
    Release of procoagulant substances from the endothelial cells.

Thrombotic
Decreased or defective platelet production.
Aplastic anemia.
Malignant cells in the bone marrow.
HIV

Nonimmune destruction - the mechanical destruction of platelets.
     Intraaortic balloon pump.
    Prosthetic heart valves. causes

Pseudothrombocytopenia

Caused by multiple transfusions of packed red blood cells which do not contain platelets.
10 units in twenty four hours.
Bleeding itself results in a loss of platelets.
Hypothermia.

Treatment of thrombocytopenia
Since there are several causes of thrombocytopenia treatment will vary.

Review patient medication.
    Discontinue those drugs which may cause thrombocytopenia.

Increase platelet production.
     Corticosteroids.
     IV imunoglobulin (IGG).
    Lithium carbonate or foliate will help the bone marrow stimulate platelet production.
    Platelet transfusion may be given.
    Splenectomy should be considered to remove the source of platelet destruction.
    Plasmaphoresis could be used to separate from whole blood those components that may cause thrombocytopenia.
    Fresh frozen plasma (FFP) may be used to assist in the control of bleeding.

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