Primary Thrombocythemia Thrombocytopenia Idiopathic Thrombocytopenic Purpura

Petichiae Gingival Bleeding Melena or Fresh Bloody stool Hemoptysis Hematemesis

Also called essential thombocythemia A stem cell disorder within the bone marrow Occurs when platelet levels are above 600,000/mm^3 Platelet size may be abnormal Functionality remains the same

Affects women twice as much as men Occurs mostly during later years, from 65 to 70 years old

Usually asymptomatic Incidentally detected via elevated platelet counts in CBC tests. Symptoms occur when platelet count exceeds 1million/mm^3 Headaches Transient ischemic attacks (T.I.A) diplopia

Spleen is enlarged but not enough to be alarming Bleeding occurs when the platelet count exceeds 1.5million/mm^3

Rule out other potential disorder such as other myeloproliferative disorders or other underlying illnesses such as secondary thrombocytosis, iron deficiency anemia, occuit malignancy. CBC shows markedly abnormal and large platelets Platelet count is persistently elevated (600,000/mm^3 or above)

Major bleeding occurs when platelet count is above 1.5million/mm^3

If bleeding is significant, transfusions of blood products are indicated, the type of product is deteremined by the kind of bleeding If fibrinolysis is excessive, hemostatic agents such as aminocaproic acid may be used.

Advise patient to avoid extreme and contact sports Examine skin for petichiae and ecchymoses. Examine nose and gums for bleeding Monitor patient for bleeding by testing all drainages and excretions for occult as well as obvious bleeding.

In Secondary Thrombocytosis, platelet production is increased. Platelet count is increased but rarely goes above 1,000,000/mm3 Platelet function is normal but lifespan is decreased.

Since platelet count is elevated and its function is still normal, symptoms associated with bleeding or thrombosis are rare.

It is a symptom of other diseases or conditions such as infection, chronic inflammatory disorder, iron deficiency, a malignant disease, acute hemorrhage or splenectomy

Consequently, treatment of Secondary Thrombocytosis is aimed at the underlying cause.

Low platelet levels as a result of many other factors. Factors include:

Decreased production of platelets Increased destruction of platelets Increased consumption of platelets

50,000/mm3
Bleeding and petechiae are not yet present

< 20,000/mm3
Petechiae Hemoptysis Gingival bleeding Excessive menstrual bleeding

< 5,000/mm3
Spontaneous CNS and/or GI bleeding, usually fatal

 Biopsy of bone marrow Decrease in platelet production

Genetic causes

Increase in platelet destruction

Elevated number of megakaryocytes as well as normal or increased platelet production

Exclude thrombocytopenia if there is a presence of ethylenediamine tetra-acetic acid (EDTA) since this causes platelets to clump together

If the cause is impaired platelet production;

Platelet transfusion

Splenectomy
Not always recommended due to other factors such as portal hypertension secondary to cirrhosis

If the cause is platelet destruction:

Platelet transfusion is rendered useless since transfused platelets are also destroyed. It is usually secondary due to Idiopathic Thrombocytopenic Purpura

A disease that affects people of all ages but more common among children and women Two types:
Acute occurs in children 1 to 6 weeks after a viral illness Chronic diagnosed after ruling out other causes of thrombocytopenia

Many people have no symptoms and the decreased platelet count is an incidental finding
Platelet count is usually < 20,000/mm3 but <5,000/mm3 is not uncommon

Easy bruising Heavy menses Petechiae of extremeties and trunk

Patients with simple bruising or petechiae (dry purpura) have fewer complications compared to those with GI and pulmonary bleeding (wet purpura) People with wet purpura have an inreased risk of intracranial bleeding

Though low in count, platelet function is still normal Thus, medical interventin is not necessary until the bleeding becomes severe or lifethreatening, or platelet count is extremely low (< 10,000/mm3)

Bone marrow aspiration shows an increased count in megakaryocytes Sometimes, there is an infection of H. pylori. Treating the infection may improve platelet count.

Important!!
Asses for a clients lifestyle before treatment begins because people with a sedentary lifestyle can tolerate low platelet levels as opposed to a person with an active lifestyle

If platelet count is above 30,00/mm3, observe If platelet count is below 20,000/mm3 or if bleeding occurs, the primary goal of treating ITP is for the platelet count to reach safe levels (> 10,000/mm3)

Withold all medications containing quinine or sulfa-based medication. Use of immunosuppresive medications
Prednisone Dexamethasone Azathioprine IVIG

Splenectomy Chemotherapy agents

Vincristine (Onovin) Rituximab

Use of the thrombopoiesis-stimulating protein romiplostin (Nplate)

Plasma transfusion is contraindicated as they are destroyed as soon as they are infused, and may instead lower platelet levels even further.

Assess clients lifestyle to identify activities for possible bleeding risks Assess medication history including use of OTC medications, dietary supplements and herbs
Take special note on the use of sulfa-containing medications and Aspirin or other NSAIDs

Avoid constipation, valsalva maneuver and vigorous flossing of teeth for gums. Avoid use of electric razors and hard bristled toothbrushes

With the exception of Factor VIII, most blood coagulating factors are formed in the liver. Therefore, dysfunction of the iver can lead to coagulating problems. Transfusion of fresh frozen plasma to replace clotting factors and prevent bleeding.

The synthesis of many coagulating factors is dependent on Vitamin K, therefore, a lack of Vitamin K can lead to bleeding disorders. Prolonged use of antibiotics decreases the intestinal flora responsible for the production of Vitamin K.