Thrombocytopenia is a low platelet count defined as less than 100,000 platelets per microliter of blood. It can be caused by problems with platelet production in the bone marrow, increased platelet destruction, or abnormal platelet distribution. Symptoms range from bruising to serious internal bleeding. Treatment depends on the severity and cause but may include medications, blood transfusions, or splenectomy. Nursing care focuses on preventing bleeding through injury prevention and careful medical management.

1. Thrombocytopinea
Done by: Mohammad AlBakari
Presented to:

2. OUTLINE
1) Definition
2) Causes
3) Risk factors
4) Pathophysiology
5) Signs and symptoms
6) Complications
7) Diagnosis
8) Treatment
9) medical management
10) Prevention
11) Patient education
12) Nursing intervention
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. Sign and Symptoms
 The Symptoms of thrombocytopenia is not oftenly seen until
the Platelets level fall down below 50 x109 /Ltr but upon falling
down from the said level clinical declaration occur.
 A level less than 30 x109 /Ltr can raise to possible symptoms
like Petechiae, menorrhagia, or spontaneous bruising.
 A level less than 10 x109 /Ltr can raise to the high-grade
bleeding.
• Spontaneous Skin Purpura.
• Mucosal Hemorrhage.
• Prolonged Bleeding After Trauma.

8. 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.

9. CAUSES

10. Failure in Platelet Production

11. Increase Destruction
Thrombocytopenia

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

14. Dilutional Loss
Massive Transfusion

15. 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)

16. 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.

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 fatal.

18. Treatments
• 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.
• 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.
• Thrombopoietic. These agents directly stimulate bone
marrow platelet production.
• Surgery. If other treatments don't help, your doctor might
recommend surgery to remove your spleen (splenectomy).
• Plasma exchange. Thrombotic thrombocytopenic purpura
can result in a medical emergency requiring plasma
exchange.

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

20. Medical Management
• 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. 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.

22. Patient Education
• Avoid activities that could cause injury. Ask your doctor
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. Ask your doctor
whether it's OK for you to drink alcohol.
• 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.

23. 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.

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/