Thrombocytopenia is a hematologic condition characterized by an abnormally low platelet count, typically defined as fewer than 150,000 platelets per microliter (μL) of blood.
Here you can find Thrombocytopenia Nursing Diagnoses and sample Thrombocytopenia Nursing Care Plans.
In this guide, you will learn about Thrombocytopenia Definition, Normal levels, Pathophysiology, Causes and Risk Factors, Signs and Symptoms, Nursing Management and more.
Thrombocytopenia Definition
Thrombocytopenia can be defined as a condition characterized by abnormally low platelet counts (< 150,000 platelets/microliter of blood).
Platelets are essential blood cells that help blood clot and prevent excessive bleeding.
Remember: The severity of thrombocytopenia and risk of bleeding generally correlates with the platelet count:
- Mild: 50,000-150,000/μL
- Moderate: 20,000-50,000/μL
- Severe: <20,000/μL
Thrombocytopenia Pathophysiology
Thrombocytopenia can result from three primary mechanisms:
1. Decreased Platelet Production
- Bone Marrow Disorders: Conditions such as aplastic anemia or leukemia can impair platelet production.
- Nutritional Deficiencies: Deficiencies in vitamin B12 or folate can hinder platelet synthesis.
- Infections: Viral infections like HIV or hepatitis C may suppress bone marrow function.
- Medications: Certain drugs, including chemotherapy agents, can damage megakaryocytes, the bone marrow cells responsible for producing platelets.
2. Increased Platelet Destruction
- Immune-Mediated Destruction: Autoimmune conditions, such as Immune Thrombocytopenic Purpura (ITP), lead to the body’s immune system attacking its own platelets.
- Drug-Induced Thrombocytopenia: Medications like heparin can induce platelet destruction, known as Heparin-Induced Thrombocytopenia (HIT).
- Disseminated Intravascular Coagulation (DIC): A condition causing widespread clotting and subsequent platelet consumption.
3. Platelet Sequestration
- Splenomegaly: An enlarged spleen can sequester (trap) an excessive number of platelets, reducing their availability in circulation.
- Liver Disease: Conditions like cirrhosis can lead to portal hypertension and splenomegaly, contributing to thrombocytopenia.
Thrombocytopenia Causes and Risk Factors
- Autoimmune Disorders: Conditions such as systemic lupus erythematosus can lead to immune-mediated platelet destruction.
- Medications: Drugs including heparin, quinine, and certain antibiotics are known to cause thrombocytopenia.
- Infections: Viral infections like Epstein-Barr virus and bacterial infections can reduce platelet counts.
- Chronic Alcohol Consumption: Excessive alcohol intake can suppress platelet production and function.
- Pregnancy: Gestational thrombocytopenia can occur, typically mild and resolving postpartum.
- Genetic Conditions: Inherited disorders like Wiskott-Aldrich syndrome can result in thrombocytopenia.
Common Causes based on:
1. Decreased Production
- Bone marrow disorders
- Vitamin B12 or folate deficiency
- Chemotherapy
- Radiation therapy
- Viral infections (HIV, hepatitis C)
2. Increased Destruction
- Immune thrombocytopenia (ITP)
- Heparin-induced thrombocytopenia (HIT)
- Systemic lupus erythematosus (SLE)
- Drug-induced immune reactions
3. Increased Consumption
- Disseminated intravascular coagulation (DIC)
- Thrombotic thrombocytopenic purpura (TTP)
- Severe infections/sepsis
- Major surgery or trauma
Thrombocytopenia Signs and Symptoms
- Cutaneous Manifestations:
- Petechiae: Small, pinpoint red or purple spots on the skin, often on the lower legs.
- Purpura: Larger purple spots caused by bleeding under the skin.
- Ecchymosis: Easy bruising without significant trauma.
- Mucosal Bleeding:
- Epistaxis: Frequent or prolonged nosebleeds.
- Gingival Bleeding: Bleeding gums, especially after brushing or flossing.
- Menorrhagia: Heavy or prolonged menstrual periods.
- Other Symptoms:
- Hematuria: Blood in the urine.
- Melena: Black, tarry stools indicative of gastrointestinal bleeding.
- Fatigue and Weakness: Due to blood loss or underlying conditions.
Thrombocytopenia Diagnostic Tests
- Complete blood count (CBC):
- Confirms low platelet count.
- Peripheral blood smear:
- Evaluates platelet size and morphology.
- Bone marrow biopsy:
- Assesses platelet production in cases of suspected bone marrow disorders.
- Coagulation studies:
- PT/INR and aPTT are usually normal unless there is an associated coagulopathy.
- Additional tests:
- Tests for underlying causes (e.g., autoimmune disorders, infections, or medications).
Medical Management of Thrombocytopenia
- Platelet transfusions
- Corticosteroids
- Immunoglobulins
- Thrombopoietin receptor agonists
- Treatment of underlying cause
Nursing Management of Thrombocytopenia
See Also: Sample Thrombocytopenia Nursing Care Plans
Nursing Assessment of Thrombocytopenia
History Taking
- Current medications (especially anticoagulants)
- Recent illnesses or infections
- Bleeding history
- Family history of bleeding disorders
- Recent trauma or surgery
Physical Assessment
- Skin assessment for petechiae/purpura
- Oral cavity examination
- Vital signs monitoring
- Neurological assessment (risk of intracranial bleeding)
Diagnostic Tests
- Complete Blood Count (CBC)
- Peripheral blood smear
- Coagulation studies (PT, PTT)
- Bone marrow biopsy (if indicated)
Nursing diagnoses of Thrombocytopenia
See Also: List Of Nursing Diagnosis For Thrombocytopenia
- Risk for excessive bleeding
- Risk for infection
- Acute Pain
- Risk for impaired skin integrity
- Inadequate health knowledge (Old ND: Deficient Knowledge)
Nursing Interventions of Thrombocytopenia
Safety Measures
- Prevent Bleeding:
- Avoid IM injections
- Use soft toothbrush
- Electric razor for shaving
- Avoid contact sports
- Fall precautions
- Monitoring:
- Regular platelet counts
- Signs of bleeding
- Vital signs
- Neurological status
- Patient Education:
- Bleeding precautions
- Signs to report
- Medication compliance
- Diet modifications
Expected Outcomes
- Platelet count improvement
- No active bleeding
- Patient understanding of the condition
- Compliance with treatment plan
- Proper use of safety measures
Emergency Interventions of Thrombocytopenia
- Apply direct pressure to bleeding sites
- Position head of bed at 30° if risk of intracranial bleeding
- Prepare for platelet transfusion if ordered
Critical Thinking Tips
- Monitor for signs of internal bleeding
- Assess bleeding risk before procedures
- Consider medication interactions
- Recognize emergency situations
- Prioritize interventions based on platelet count
Documentation Tips for Thrombocytopenia
- Accurate bleeding assessment
- Platelet counts and trends
- Response to interventions
- Patient education provided
- Any adverse events
Patient Education Tips for Thrombocytopenia
- Medication Management:
- Purpose of medications
- Side effects
- Compliance importance
- Drug interactions
- Lifestyle Modifications:
- Activity restrictions
- Diet recommendations
- Safety measures at home
- When to seek medical attention
- Follow-up Care:
- Appointment scheduling
- Laboratory monitoring
- Emergency contact information
- Support resources
Conclusion
Thrombocytopenia is a condition that requires careful assessment, monitoring, and patient education to prevent complications.
As nurses, you play a critical role in identifying at-risk patients, implementing bleeding precautions, and providing compassionate nursing care.
References:
- Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). (2024). NANDA International nursing diagnoses: Definitions and classification, 2024–2026 (13th ed.). Thieme.
- Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.
- Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2021). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care.
