| Question | Answer |
| thrombocytopenia | platelet count < 150,000 |
| immune thrombocytopenia | platelets function normally but are destroyed by macrophages due to their coating with antibodies |
| treatment for ITP | corticosteroids, IV immunoglobulin, splenectomy |
| signs and symptoms of ITP | bruising, headache, SOB, confusion, fever, weakness |
| idiopathic causes of ITP | H.Pylori, flu or unknown |
| Thrombotic Thrombocytopenia Purpura | always associated with hemolytic-uremic syndrome and platelets aggregate which form micro-thrombi that are deposited into arterioles and veins |
| causes of TTP | idiopathic, drug reactions, pregnancy or autoimmune |
| TTP treatment | treat underlying cause, plasmapheresis (reverses platelet consumption), immunosuppressants |
| signs and symptoms of TTP | fever, neruo, renal, anemia, platelets |
| heparin induced thrombocytopenia and thrombosis syndrome | usually occurs 5-10 days after onset of heparin therapy |
| when to suspect HITTS | if platelet count falls past 50% or < 150,000 |
| signs and symptoms of HITTS | bleeding, petechiae, pain/ tenderness, weakness of arm/ leg |
| clinical manifestations of internal blood loss | fainting, dizziness, tachycardia, weakness, abdominal pain, hypotension |
| treatment of HITTS | direct thrombin inhibitor to maintain anticoagulation (Lepirudin, Argatroban)
plasmapheresis if severe to clear blood of platelet aggregating substances
can give warfarin for thrombosis after platelet count is > 150,000 |
| Disseminated Intravascular Coagulation (DIC) | results from abnormally initiated and accelerated clotting
subsequent decreases in clotting factors and platelets ensue which can lead to uncontrollable hemorrhage |
| acute DIC risk factors | shock, septicemia, tissue damage, snake bite, head injury |
| subacute DIC risk factors | malignancy, obstetric |
| chronic DIC risk factors | liver disease, lupus, malignancy |
| bleeding clinical manifestations | skin - pallor, petechiae, hematomas
respiratory- tachypnea, hemoptysis, orthopnea
cardio- hypotension and tachypnea
neurologic - vision changes, dizziness, changes in mental status, irritability |
| thrombotic clinical manifestations | skin- cyanosis, ischemic tissue necrosis, hemorrhagic necrosis, bloody stools
respiratory- tachypnea, dyspnea, pulmonary emboli, ARDs
cardio- ECG changes, venous distention
renal failure, AKI, oliguria |
| diagnostic studies | prolonged PT, prolonged PTT, low fibrinogen, low platelets, elevated fibrin, elevated D-Dimer |
| medical management of DIC | stabilize (oxygen and volume replacement)
heparin (Thrombosis)
chronic DIC with no bleeding - treat cause
chronic DIC with bleeding- blood products
chronic DIC who does not respond to oral anticoagulants- long term heparin |
| nursing management of DIC | active assessment, minimize damage to tissue and protect patient from additional sources of bleeding
early detection of bleeding |
