THROMBOCYTOPENIC PURPURA
• PRESENTED BY
• KIRAN KUMARI YADAV
• MSC NURSING 1ST YEAR
INTRODUCTION
It is an autoimmune disorder characterized by antibody- mediated
destruction of platelets.
It is a self-limiting disorder, which usually resolves spontaneously
within a few months of onset.
It can occur at any age.
Incidence is 4 to 8 per 1000 per year
DEFINITION OF IDIOPATHIC THROMBOCYTOPENIC
PURPURA
Idiopathic thrombocytopenic purpura is a blood disorder characterized by
an abnormal decrease in the number of platelets in blood. It can result
in easy bruising, bleeding gums and internal bleeding.
ETIOLOGY AND RISKFACTORS of THROMBOCYTOPENIC
PURPURA
Genetic predisposition
Autoimmune
Viral infection
Sepsis, severe bacterial infection in your blood.
Pregnancy
Surgery and blood and marrow stem cell transplant.
Drugs
TYPES OF THROMBOCYTOPENIC PURPURA
1. Autoimmune (idiopathic)
thrombocytopenic purpura
2. Thrombotic
thrombocytopenic purpura
3. Drug induced
thrombocytopenic purpura
1)AUTOIMMUNE THROMBOCYTOPENIC PURPURA
ITP is a disease that affects people of all ages, but it is more common among
children and young women.
There are two forms of ITP
Acute Thrombocytopenic Purpura
Chronic Thrombocytopenic Purpura
2. THROMBOTIC THROMBOCYTOPENIC PURPURA
TTP is a blood disorder that results in blood clots forming in small blood
vessels throughout the body.
This results in low platelet count, low red blood cells due to their
breakdown & often kidneys, heart and brain dysfunction.
3. DRUG- INDUCED THROMBOCYTOPENIC PURPURA
Drug – induced thrombocytopenic purpura is a skin condition result from
a low platelet count due to drug induced anti- platelet antibodies caused
by drugs such as heparin, sulfonamines, digoxin, quinine & quinidine.
CLINICAL MANIFESTATION OF THROMBOCYTOPENIC
PURPURA
Low platelet count
Hemorrhage may be mild or severe.
Easy bruising, Menorrhagia & petechiae on the extremities or trunk.
Ecchymosis
Severe bleeding from mucous membrane
Hematuria / proteinuria
Splenomegaly
Bleeding in internal organs
Abdominal pain , nausea , vomiting, fatigue , fever .
DIAGNOSTIC TEST OF THROMBOCYTOPENIC PURPURA
History collection
Physical examination
CBC
Coagulation profile: BT, CT, PT, APTT, Platelet count.
Blood urea , creatinine, serum bilirubin , serum LDH
PBS ( Peripheral blood smear )
Bone marrow examination
Direct comb's test
MEDICAL MANAGEMENT
Aim of treatment is to prevent life threatening bleeding.
Corticosteroids
Monoclonal Antibodies ( anti- CD20 rituximab)
Intravenous immunoglobulin (IVIG)
Platelet transfusion
FFP: 10-20ml/kg body weight
Chemotherapy agents
I/V Anti-D therapy for Rh- positive patient , dose of 50- 75microgram/kg
SURGICAL MANAGEMENT
SPLENECTOMY: May be considered , as platelets which have been
bound by antibodies are taken by macrophages in the spleen. Spleen
is the main site for the production of antibodies & destruction of
antibody – coated platelets. If the bleeding is refractory to IVIG ,
splenectomy should be performed.
NURSING MANAGEMENT
ASSESSMENT
Assess the skin color for bruising, ecchymosis, petechiae.
Observe the & report the amount and location of bleeding episodes.
Check the laboratory investigations such as platelet count daily.
Assess the hydration status of patient.
NURSING DIAGNOSIS
1. Risk for bleeding related to decreased platelet count.
2. Risk for fluid volume deficit related to bleeding.
3. Risk for impaired skin integrity related to ischemia or bleeding.
4. Risk for injury related to abnormal blood profile.
5. Risk for infection related to suppression of the immune system by
steroids.
NUSING INTERVENTIONS
Monitor vital sign & record 6 hourly & report any deterioration.
Encourage the patient to eat dark green leafy vegetables. They
promote clotting.
Secure IV line for fluids , medication & possibly blood transfusion.
Apply pressure on puncture sites for 5 to 10 minutes.
Monitor stool, urine and vomitus for blood.
Apply infection prevention measures such as hand washing,& sterility
during procedures.
CONT..
Teach the patient use a soft toothbrush to prevent gum mucosal
bleeding.
Protect area of petechiae from further injuries.
Obtain blood samples for Hb level and platelet count daily.
Monitor glucose level daily.
Maintain intake and output charting.
Monitor weight daily..
CONCLUSION
Idiopathic thrombocytopenic purpura is hematological disorder,
characterized by isolated thrombocytopenia without a clinically apparent
cause. The major causes of accelerated platelet consumption include
immune thrombocytopenia, decreased bone marrow production and
increased splenic sequestration.
REFERENCES
Brunner and Suddharth’s, “Textbook of Medical- Surgical Nursing” Published by
Wolters Kluwer,11th edition (2019), volume I, page no.742 to 745.
Joyce M. Black, Hawks, “Textbook of Medical- Surgical Nursing” Elsevier
Publication; 8th edition; volume II; page no: 2032 to 2034.
Mani Mrinalini Chintamani “Lewis’s Medical Surgical Nursing” Elsevier Second
south Asia Edition (2015) volume1, page no – 684 to 685.
Lakshmanaswamy.Aruchaamy, Clinical Paediatrics, History taking and care
discussion, Published by Wolters Kluwer(INDIA) Pvt Ltd. New Delhi ,3rd Edition
(2011) page no – 690 to 692.
