Platelet Disorders

Question 1

Platelet Disorders - Reasons

Answer 1

• Dcrd production
  > from cancers & treatment, aplastic anemia, toxins, meds, alcohol
• Incrd destruction
  > autoimmune disorder
  > infections, meds, spleen disorder, cancers
• Incrd consumption
  > body makes enough but body eats them up
  > disseminating intravascular coagulation (DIC): body making microvascular clots & running out of platelets

Question 2

Thrombocytopenia

Answer 2

• Too few
• 40,000-80,000/mm3: risk for bleeding w/ mild trauma
• <20,000: risk for spontaneous bleed
• <5000/mm3: risk for fatal bleed in CNS or GI hemorrhage
• Idiopathic Thrombocytopenic Purpura (ITP)

Question 3

Thrombocytosis

Answer 3

• Too many
• Platelet count above normal >600,000/mm3
  > risk for clotting
• Thrombotic Thrombocytopenic Purpura

Question 4

Idiopathic Thrombocytopenic Purpura (ITP) - Pathophysiology

Answer 4

• Autoimmune Disorder
• Pts make antibodies against own platelets; macrophages destroy
  > viral infections throught to trigger condition
  > most common in women 20-40

Question 5

Idiopathic Thrombocytopenic Purpura (ITP) - Diagnosis

Answer 5

• Serial low platelets
• Bone marrow biopsy

Question 6

Idiopathic Thrombocytopenic Purpura (ITP) - Treatment

Answer 6

• Immunosuppressive drugs
  > Prednisone
  > due to risk of infection
• Platelet transfusion
• Splenectomy
  > last resort; destroyed platelets are stored in spleen & could rupture

Question 7

Thrombotic Thrombocytopenia Purpura - Pathophysiology

Answer 7

• Autoimmune Disease:
  > Platelets clump together abnormally in capillaries & too few available in circulation
  > Inappropriate clotting but also fails to clot when trauma occurs
  > tissue becomes ischemic may lead to kidney failure, MI, CVA; untreated fatal in 3 months

Question 8

Thrombotic Thrombocytopenia Purpura - Treatment

Answer 8

• Plasmapheresis
• Fresh frozen plasma to provide platelet aggregation inhibitors
• Platelet inhibitor drugs
  > Clopidogrel
  > Aspirin

Question 9

Hemophilia

Answer 9

• Genetic disorder 1 in 10,000
  > X linked recessive trrait
  > women carrier (50% chance of passing gene to offspring)
• Types
  > Type A - Factor VIII (8) deficiency (80% of cases)
  > Type B - Factor IX (9) deficiency (20% of cases)

Question 10

Hemophilia - Symptoms

Answer 10

• Abnormal bleeding to any trauma, specifically joints
• Bleed longer than normal
• Problem forming stable fibrin clot

Question 11

Platelet Labs - Prothrombin Time (PT)

Answer 11

• 11-12.5 seconds
• Significance
  > Prolonged: Warfarin therapy, clotting factor deficient, liver failure

Question 12

Platelet Labs - International Normalized Radtion (INR)

Answer 12

• 0.8-1.1
• Significance
  > standard measure for PT

Question 13

Platelet Labs - Partial Thromboplastin Time (PTT)

Answer 13

• Assesses intrinsic clotting cascade & level of clotting factor: II, V, VIII, IX, XI, XII
• 60-70 seconds
• Significance
  > Prolonged: heparin therapy, clotting facotr deficient (hemophilia)
  > Autoimmune: abnormal attack of clotting factors

Question 14

Hemophilia - Medical Management

Answer 14

• Most Common Complication:
  > joint problems from repeated episodes of bleeding

Question 15

Hemophilia - Diagnosis

Answer 15

PTT prolonged

Question 16

Hemophilia - Treatment

Answer 16

Replace missing factor w/ infusion of synthetic factors

Question 17

Hemophilia - Nursing Management

Answer 17

• Minimize trauma & other causes of bleeding
  > troombocytopenia precautions
  > risk assessment: protect pt from injuries: padding side rails, ambulate w/ assistance
• Assess for signs & symptoms of bleeding
• Interdisciplinary
  > prepare to administer platelet transfusions for counts below < 10,000mm3
  > replace missing clotting factors w/ infusion of synthetic factors
  > educate pt & fam: risk of bleeding