Thrombocytopenia: class 3

Question 0

Platelet

-Action

Answer 0

1. Adhere to the wall of an injured vessel

Question 1

Platelets

Answer 1

1. Formed by bone marrow as megakaryocytes
2. Survive 8-10 days
3. Only fragments of cytoplasm (not cells)
4. Produced in bone marrow
5. Stored in spleen and removed by the speen

Question 2

Thrombocytosis

Answer 2

1. Excess of platelets (over 450,000)

Question 3

Thrombocytopenia

Answer 3

1. PLT count < 150,000

Question 4

Anticoagulants

Answer 4

1. Decrease platelet aggregation

2. Prevent further clots from forming

Question 5

Fibrinolytics

Answer 5

1. Lyse clots that have formed and prevent clotting

Question 6

Hemostasis (clotting)

-process

Answer 6

1. Thromboxane A2 released when vessel spasms and vessel constricts
2. Formation of platelet plug
   - platelets attach to vessel wall and each other
   - fibrin holds plug together

Question 7

Prothrombin Time (PT) & INR
-Normal values

Answer 7

1. PT : 10-12 seconds

2. INR: 0.8-1.2

Question 8

Therapeutic INR

-Value?

Answer 8

1. 2.5

Question 9

Activated partial thromboplastin time (aPTT)

-Normal levels

Answer 9

1. 30-40 seconds

Question 10

Activated partial thromboplastin time (aPTT)

-Therapeutic Levels

Answer 10

1. 1.5-2.5 X normal

Question 11

PT & INR

-What drug? What antidote?

Answer 11

1. Warfarin (coumadin)

2. Antidote is Vitamin K

Question 12

aPTT

-What Drug? What antidote?

Answer 12

1. Heparin

2. Protamein Sulfate

Question 13

Thrombocytopenia

-considerations

Answer 13

1. PLT count < 150,000
2. <10,000
   - Spontaneous bleeding (rarely can cause intracranial bleed)

Question 14

Petechiae & Purpura

Answer 14

1. Petechiae are the small dots of blood

2. Purpura are the larger bruises

Question 15

Thrombocytopenia

-things to do w/ pt’s

Answer 15

1. Hold pressure over injection sites, IV sticks and blood draw sites
2. Ensure clotting is occurring

Question 16

Idiopathic Thrombocytopenia Purpura (ITP)

Answer 16

1. Autoimmune, accelerated PLT destruction
2. More common in:
   - children
   - young women with systemic LUPUS erythematosus

Question 17

Idiopathic Thrombocytopenia Purpura (ITP)

-How it happens

Answer 17

1. Platelets function normally
2. PLT’s are destroyed early in the spleen
   - antibodies mark PLT’s are foreign causing spleen to attack
   - destroyed in 1-3 days

Question 18

Thrombocytopenia

-Diagnostics

Answer 18

1. PLT Count (150K - 450K)
2. Hgb & Hct (aplastic can also cause low H&H)
3. Rule out:
   - Leukemia and Lymphoma
   - Lupus
   - HIT

Question 19

Thrombocytopenia

-Clinical Manifestations

Answer 19

1. Asymptomatic
2. Bleeding
   - Cutaneous
   - mucosal
   - petechiae
   - ecchymosis
   - hemmorrhage

Question 20

Thrombocytopenia

-Treatment

Answer 20

1. Oral steroids are first (glucocorticoids)
2. Splenectomy is tried next
3. Immunoglobulin therapy next
4. Platelet therapy
   - Only used if the person is bleeding to reverse hemorrhage

Question 21

Thrombotic Thrombocytopenia Purpura (TTP)

Answer 21

1. Idiopathic
2. Can be caused by drugs / pregnancy / infection/ chemo /
3. Enhances agglutination of platelets forming microthrombi

Question 22

Thrombotic Thrombocytopenia Purpura (TTP)

-stats

Answer 22

1. Is more common in women

2. Occurs in 1/25,000 pregnancies

Question 23

Thrombotic Thrombocytopenia Purpura (TTP)

-Treatment

Answer 23

1. Plasmapheresis

- decreases mortality rate from 90% to 20%

Question 24

Plasmapheresis

Answer 24

1. Removal of plasma in replacement with donors fresh frozen plasma to remove the antibodies

Question 25

Drug Induced Thrombocytopenia

Answer 25

1. First seen in Pt's receiving QUININE - Multiple medications at once - Use of multiple blood products - Rule out other causes 2. Can be Immune or non-Immune response

Question 26

Quinine and Thrombocytopenia

Answer 26

1. Drug-induced thrombocytopenia is first seen in patients receiving quinine - can also be caused by chemotherapeutic drugs

Question 27

Drug-Induced Thrombocytopenia | -Manifestations

Answer 27

1. Petechiae 2. Bruising 3. Epistaxis (hemorrhage or bleeding from the nose)

Question 28

Drug Induced Thrombocytopenia | -Nursing Priority

Answer 28

1. Stop the offending Drug ***

Question 29

Heparin-induced Thrombocytopenia | -What is it?

Answer 29

1. Immune mediated response to heparin 2. Promotes PLT aggregation 3. Decreased circulating PLT's 4. Heparin is neutralized

Question 30

Heparin-induced Thrombocytopenia (HIT) | -Nursing consideration?

Answer 30

1. HIT usually occurs 4-14 days after initiation | 2. Pt should be monitored every other day from day 4-14 of heparin administration to detect drop

Question 31

Heparin-induced Thrombocytopenia 1 | - HIT-1

Answer 31

1. A slight drop in the PLT count after initiation

Question 32

Heparin-induced Thrombocytopenia 2 | - HIT-2

Answer 32

1. Thrombosis and thrombocytopenia

Question 33

Clinical Scoring SYstem for HIT | -Score of 0-3?

Answer 33

1. Pt is at low risk

Question 34

Clinical Scoring System for HIT | -Score of 4-5?

Answer 34

1. Intermediate Risk

Question 35

Clinical Scoring System for HIT | -Score of 6-8

Answer 35

1. High risk of developing HIT

Question 36

HIT-2 | -Treatment

Answer 36

1. STOP the offending agent immediately 2. Give Thrombin inhibitor 3. Plasmapheresis (Plasma exchange therapy) 4. Protamine Sulfate 5. THrombolytics

Question 37

If Pt with HIT-2 still needs anticoagulation therapy, Use???

Answer 37

1. Arixtra