Lippincott Certification Review Medical-Surgical Nursing

131

Thrombocytopenia

●● Diagnosis and treatment ●● Laboratory tests include a CBC with differential, revealing increased RBCs, hemoglobin, and hematocrit, which can initially exceed 60%; elevated erythropoietin levels; elevated leukocyte and platelet counts; and often increased uric acid levels. ●● Treatment aims to reduce the high blood cell mass; therapeutic phlebotomy is performed to keep hematocrit below 45%. ●● Drug therapy may include cytoreductive agents, including hydroxyurea (Hydrea or Droxia), ruxolitinib (Jakafi), interferon alfa, and busulfan (Myleran) to suppress bone marrow function, as well as platelet inhibitors like aspirin. ●● Nursing interventions ●● Monitor and educate the patient and family about thrombotic complications such as deep vein thrombosis, and observe for excessive bleeding. ●● Monitor for signs and symptoms of infection. ●● Provide supportive care; treat pain with pain medication as ordered and supportive care; treat pruritus with warm or cool baths and antihistamines as ordered. ●● Teach the patient and family about the disease process, monitoring, and treatment regimens and how to prevent complications. ●● Provide emotional support. ●● Thrombocytopenia occurs when there is an abnormally low level of circulating platelets (less than 100,000/mm 3 ) due to decreased production, decreased survival, increased destruction, or increased sequestration of platelets in the spleen. ●● It may result from antibody production (idiopathic thrombocytopenic purpura), bone marrow radiation, excessive alcohol use, folate deficiency, or a disease, such as aplastic anemia or leukemia, DIC, hypothermia, or an autoimmune disorder. ●● Acquired platelet dysfunction may be caused by drugs, including aspirin, P2Y12 inhibitors (clopidogrel), and glycoprotein IIb/IIIa receptor inhibitors (eptifibatide). ●● Signs and symptoms ●● Ecchymosis, petechiae, and purpura may affect the skin. ●● Epistaxis, gingival bleeding, severe hemorrhage, and menorrhagia also may occur. ●● Diagnosis and treatment ●● Diagnosis is made by examining several laboratory tests, including a CBC with differential (noting the platelet count), blood smear, PT/PTT (clotting times), and bone marrow biopsy and sample to determine whether the platelet loss is caused by lack of production or increased destruction. ●● Treatment focuses on correcting the underlying cause. ●● For thrombocytopenic purpura, the principal treatment is corticosteroid therapy; IV immune globulin may also be used; for severe or resistant cases, immunosuppressant therapy or splenectomy may be used; platelet transfusions are not helpful because of continued platelet destruction. ●● For other types of thrombocytopenia, platelet transfusions are indicated for supportive care until the underlying cause can be treated. ●● Nursing interventions ●● Monitor platelet counts; the patient is more susceptible to injury and bleeding when the platelet count falls below 60,000/mm 3 and may develop spontaneous hemorrhage, particularly cerebral hemorrhage, when the platelet count drops below 20,000/mm 3 . ●● Monitor and test stools and urine for blood. ●● Avoid taking the patient’s temperature rectally and giving injections IM.

Thrombocytopenia ●● Description

●● Apply pressure to venipuncture and arterial puncture sites. ●● Provide meticulous oral care to prevent bleeding and infection. ●● Tell the patient to use only an electric razor and a soft toothbrush and to avoid contact sports, elective surgery, tooth extraction, and the use of aspirin and ibuprofen. Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.