 Failure of normal haemostatic mechanisms can result in

bleeding, which may be severe.

 This bleeding is commonly provoked by trauma, but in certain
circumstances it can occur spontaneously.
 SOURCE: Platelet or coagulation factor abnormalities leads to
bleeding can be anywhere in the body.
 SOURCE: Vascular abnormalities leads to bleeding which
may be localized.
 Abnormalities of the vascular system give rise to local
bleeding, usually into the skin.
 Abnormalities of coagulation factor defects give rise to deeper
bleeding within the body(e.g., subcutaneous or IM
hematomas, hemorrhage into the spaces).
 Management varies based on the underlying cause of the
bleeding disorder.
 TRANSFUSION of blood products.
 The patient need to understand the importance of avoiding
activities that increase the risk of bleeding, such as sports
person.
 It is necessary to examine the skin for petichae&
ecchymosis(bruises), the nose and the gums for bleeding.
 Hospitalized patients should be monitored for bleeding by
testing all drainage & excreta(Feces, urine, emesis and gastric
drainage).
 Check for occult blood in the stool.
 Primary
Thrombocyt
openia

Idiopathic
Thrombocyt Secondary
CLASSIFICATI
openic Thrombocyt
ON
Purpura(ITP osis
)

Thrombocyt
openia
 Low doses of aspirin(It can relive the neurologic s/s).
 Hydroxyurea(Effective in lowering platelet count).

 Interferon-alfa-2b(S.C 3 times per week).

 INCREASED PLATELET PRODUCTION is the primary
mechanism of secondary, or reactive, thrombocytosis.
 It is a rare condition, Platelet increases more than 1
million/mm3.
 Infection.
 Chronic Inflammatory Diseases.
 Iron Deficiency Anemia.
 Malignant disease.
 Acute Hemorrhage.
 Spleenectomy.
 AIM:
 To treat underlying disease.
 With successful management the platelet count usually
returns to normal.
 Decreased Platelet Production:
 Hematologic malignancy.
 Myelodysplastic syndrome (MDS).
 A plastic anemia.
 Megaloblastic anemia.
 Toxins.
 Medications(Sulfa drugs, Methotrexate).
 Infection.
 Alcohol.
 Chemotherapy.
 Increased Platelet Production:
 Idiopathic thrombocytopenic purpura(ITP).
 Lupus erythematous.
 Malignant lymphoma.
 Chronic Lymphocytic leukemia.
 Medications.
 Bactremia.
 Post viral infections.
 Sequestration of platelets in an enlarged spleen.
 Increased platelet consumption:
 Disseminated Intravascular Coagulation(DIC).
 Risk for injury/bleeding secondary to thrombocytopenia.
 Fatigue related to anemia or infection.

 Risk for fluid volume deficit related to bleeding.

 Knowledge deficit related to bleeding management.

 It is an acute hemorrhagic disorder characterized by excessive
destruction of platelets.
INCIDENCE:
 It affects people of all ages.

 Common in: Children & Young women.

2 Forms Of ITP:
 ACUTE
 CHRONIC
ACUTE:
 Predominantly occurs in children.

 Appears 1 to 6 weeks after a viral illness.

 Remission occurs spontaneously within 6 months,

CHRONIC:
 By exclusion of other causes of thrombocytopenia.
 Viral illness.
 Medications: Sulfa drugs.

 Systemic lupus erythematous can induce ITP.

 Pregnancy can induce ITP.

Viral illness Autoimmune disease

Measles, Mumps, Hemolytic Anemia

Rubella & chicken pox

ACUTE ITP CHRONIC ITP

Production of auto antibodies

Attacks &destroys thrombocytes

Platelet count below 20,000/mm3

Hemorrhage from trauma/surgery, petichae, ecchymosis, hematoma formation

Bleeding from mucous membranes( Hematuria, Epitaxis, Hemetemesis,

Hemoarthrosis)
 Many patients have no symptoms.
 Low platelet count.
 Easy Bruising.
 Heavy Menses.
 Petichae in the extremities or trunk.
 CBC
 Bone marrow Aspiration( Increased megakaryocytes&
decrease in platelets)
 Immunosuppressive agents (e.g.., Corticosteroids)
 IVIG is commonly used.
 Chemotherapy.
 Vincristine
 Monoclonal antibodies(e.g.., Rituximab).
 Thrombopoesis- stimulating protein romiplastin(N Plate) can
be used in patients with chronic ITP.
 Platelet Transfusion are AVOIDED because the patient’s
Antiplatelet antibodies binds with the new transfused platelets,
causing them to be destroyed.
 Patient’s who have undergone spleenectomy are permanently
at risk of sepsis so they should receive pneumococcal vaccine
(Pneumovax), H.inflenzae B & Meningococcal vaccines (2 to
3 weeks before spleenectomy is performed).
 The pneumococcal vaccine should be repeated at 5 to 10 years
intervals.
 The nurse must be alert for sulfa containing drugs & others
that alters the platelet function( e.g.., Aspirin based or other
NSAIDS).
 Assess for any h/o recent viral illness & reports of headache or
visual disturbances which could be a initial symptom of
intracranial hemorrhage.
 Avoid rectal examinations & Injections.
 Avoid valsalva maneuver( Straining at stool) and vigorous
flossing of the teeth.
 Calcium,Vitamin D supplements and bisphosphonate therapy
to prevent significant bone disease.