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1. Thrombocytopenia
Done by : Mohammad Albakari
Presented to : Dr. Acil Sawdah

2. OUTLINE
1) Definitions
2) Pathophysiology
3) Risk Factors
4) Etiology
5) Signs and symptoms
6) Complications
7) Diagnosis
8) Treatment
9) Nursing and Medical
Management
10) Nursing intervention
11) Preventions
12) Patient education
13) references

3. DEFINITION
Thrombocytopenia
• Thrombocytopenia defines a subnormal number of
platelets in the circulating blood, usually below 100 ×
109/L.
• A normal human platelet count ranges from 150,000 to
450,000 platelets per microliter of blood.

4. Thrombocytopenia

5. Statistics and Incidences
• Incidence rates of idiopathic thrombocytopenic purpura (ITP) are as follows:
• An average estimate of the incidence in children is 50 cases per 1,000,000 per
year.
• New cases of chronic refractory ITP comprise approximately 10 cases per
1,000,000 per year
• According to studies in Denmark and England, childhood ITP occurs in
approximately 10-40 cases per 1,000,000 per year.
• A prospective, population-based study in Norway indicated an incidence of 53 per
1,000,000 in children younger than 15 years.
• A study in Kuwait reported a higher incidence of 125 cases per 1,000,000 per year.
• The mortality rate from hemorrhage is approximately 1% in children and 5% in
adults.
• Spontaneous remission occurs in more than 80% of cases in children.
• Peak prevalence occurs in children aged 2-4 years.
• Approximately 40% of all patients are younger than 10 years.

6. Pathophysiology
• The bleeding results from unusually low levels of platelets — the
cells that help blood clot.
• ITP is primarily a disease of increased peripheral platelet
destruction, with most patients having antibodies to specific
platelet membrane glycoproteins.
• Relative marrow failure may contribute to this condition since
studies show that most patients have either normal or
diminished platelet production.
• Acute ITP often follows an acute infection and has a
spontaneous resolution within 2 months.
• Chronic ITP persists longer than 6 months without a specific
cause.

7. Risk Factors of
Thrombocytopenia
 Have certain types of cancer, aplastic anemia, or
autoimmune diseases
 Are exposed to certain toxic chemicals
 Have a reaction to certain medicines
 Have certain viruses
 Have certain genetic conditions
 People at highest risk also include heavy alcohol
drinkers and pregnant women.

8. Etiology
• Thrombocytopenia might occur as a result of a bone
marrow disorder such as leukemia or an immune system
problem. Or it can be a side effect of taking certain
medications. It affects both children and adults.
• And can be classified in to :Failure of platelet production,
increase destruction of platelets(in some diseases such as
leukemia),abnormal destruction of platelets(lupus, and
rheumatoid arthritis) ,Dilutional loss

9. Failure in Platelet Production

10. Increase Destruction
Thrombocytopenia

11. Abnormal Distribution of
platelets
 Increased sequestration i-e Hypersplenism
 Splenomegaly

13. Dilutional Loss
Massive Transfusion
Is the platelet loss
out of the body and
platelet dilution with
replaced red cells
and crystalloids.

14. Thrombocytopenia Due to Failure
Production of Platelets
 Most common cause of thrombocytopenia and occur due to
Selective Bone Marrow Suppression for producing
Megakaryocytes Fragments.
 Bone marrow Failure can be occurred due to the Following:
• Cytotoxic Drugs & Radiotherapy (Direct effect the Bone marrow)
• Aplastic Anemias
• Leukemia
• Myelofibrosis
• Marrow Infiltration (e.g. Carcinoma, Lymphoma)
• Megaloblastic Anemias
• HIV Infection (Direct effect the Megakaryocyte)

15. Sign and Symptoms
 Thrombocytopenia signs and symptoms may include:
1) Easy or excessive bruising (purpura)
2) Superficial bleeding into the skin that appears as a rash of
pinpoint-sized reddish-purple spots (petechiae), usually on the
lower legs
3) Prolonged bleeding from cuts
4) Bleeding from your gums or nose
5) Blood in urine or stools
6) Unusually heavy menstrual flows
7) Fatigue
8) Enlarged spleen

17. Complications
Dangerous internal
bleeding can occur
when your platelet
count falls below
10,000 platelets per
microliter. Though rare,
severe
thrombocytopenia can
cause bleeding into the
brain, which can be

18. Diagnosis
The following can be used to determine whether you have
thrombocytopenia:
1)Blood test: A complete blood count determines the number
of blood cells, including platelets, in a sample of your blood.
2)Physical exam, including a complete medical history:
(look for signs of bleeding under your skin and feel your
abdomen to see if your spleen is enlarged).
3)Imaging studies: A CT scan of the head is warranted if
concern exists regarding intracranial hemorrhage.

19. Treatments
1) Blood or platelet transfusions: If your platelet level
becomes too low, your doctor can replace lost blood with
transfusions of packed red blood cells or platelets.
2) Medications: If your condition is related to an immune
system problem, your doctor might prescribe drugs to boost
your platelet count. The first-choice drug might be a
corticosteroid.
3) Thrombopoietic: These agents directly stimulate bone
marrow platelet production.
4) Surgery: If other treatments don't help, your doctor might
recommend surgery to remove your spleen (splenectomy).
5) Plasma exchange:Thrombotic thrombocytopenic purpura
can result in a medical emergency requiring plasma

20. Nursing and Medical
Management
 Treatment may include a number of approaches, such as
medications to boost platelet count or surgery to remove spleen
(splenectomy).
 Prehospital care: Prehospital care focuses on the ABCs (airway,
breathing, circulation), which include providing oxygen, controlling
severe hemorrhage, and initiating intravenous (IV) fluids to maintain
hemodynamic stability
 Emergency department care: Life-threatening bleeding requires
conventional critical care interventions; in the patient with known ITP,
high-dose parenteral glucocorticoids and IV immunoglobulin (IVIg),
with or without platelet transfusions, are appropriate.
 Consultations: Consult a hematologist for assistance in confirming
the diagnosis or, in the patient with known ITP, arranging disposition
and follow-up care, if appropriate.

21. Nursing Interventions
 Prevent bleeding: Review laboratory results for
coagulation status as appropriate: platelet count,
prothrombin time/international normalized ratio
(PT/INR)
 Prevent injury: Thoroughly conform patient to
surroundings; put call light within reach and teach
how to call for assistance.
 Prevent infection: Wash hands and teach patient
and SO to wash hands before contact with patients
and between procedures with the patient.

22. Prevention of
Thrombocytopenia
 Avoid heavy drinking. Alcohol slows the production of platelets.
 Try to avoid contact with toxic chemicals. Chemicals such as
pesticides, arsenic, and benzene can slow the production of
platelets.
 Avoid medicines that you know have decreased your platelet
count in the past.
 Be aware of medicines that may affect your platelets and raise
your risk of bleeding. Two examples of such medicines are
aspirin and ibuprofen. These medicines may thin your blood
too much.
 Talk with your doctor about getting vaccinated for viruses that
can affect your platelets.

23. Patient Education
 Avoid activities that could cause injury: which activities
are safe for you. Contact sports, such as boxing, martial
arts and football, carry a high risk of injury.
 Drink alcohol in moderation, if at all: Alcohol slows the
production of platelets in your body.
 Use caution with over-the-counter medications: Over-
the-counter pain medications, such as aspirin and
ibuprofen (Advil, Motrin IB, others) can prevent platelets
from working properly.

24. References
 https://www.mayoclinic.org/diseases-
conditions/thrombocytopenia/diagnosis-treatment/drc-20378298
 https://nurseslabs.com/idiopathic-thrombocytopenic-
purpura/#:~:text=Based%20on%20the%20assessment%20data,re
lated%20to%20altered%20kinesthetic%20perception.
 https://www.hoacny.com/patient-resources/blood-disorders/what-
thrombocytopenia/risk-factors-thrombocytopenia
 https://www.hoacny.com/patient-resources/blood-disorders/what-
thrombocytopenia/screening-and-prevention-thrombocytopenia
 https://oxfordurgentclinic.com/internal-bleeding-symptoms/