Okay, now, let's look at the cause of thrombocytopenia,
'thrombo' tells us we're talking about the platelets; 'cytopenia' we've got low cells.
Now, there's several reason but there's a common theme here:
anybody who has low platelets or thrombocytopenia is gonna be at an increased risk for bleeding.
So, you wanna handle these patients with care.
Now, depending on how low the platelets are and the other factors that are going on,
there might be a minor risk such as increased bruising or it could be a significant risk of life-threatening hemorrhage.
You're gonna see a lot of different causes appear on the screen.
Hard to keep them all in line but I just want to give you some ideas of the things
that we would think through if we saw someone with a low platelet count.
Remember, you'll have to do some additional testing to figure out what the actual cause is,
but these are the items that we would consider.
This might be a sign that the bone marrow is failing; the patient's been on chemotherapy,
they have a viral infection, maybe lupus, leukemia or lymphoma.
Oh, wait a minute, look at that, you've got leukemia on both sides of the coin there, right?
Either low or high. Just keep in mind, an abnormal platelet count
sometimes will have similar causes that's why we say you have to do additional testing to find out what's going on.
Now, there's something called idiopathic thrombocytopenia purpura, now, it's a mouthful.
You just heard me try to say it. Idiopathic is just a very fancy sounding word that says,
we don't know why you have this condition.
So, we have it with some people where we don't actually know what the cause is.
HELLP syndrome is a severe syndrome that happens after pregnancy and an increased risk for bleeding problems.
We have DIC which is a horrific problem. Often, knee syndromes can be fatal, both HELLP or DIC.
And last, we're going to talk about platelet sequestering.
Sometimes, when you have really big spleen, splenomegaly, means really large spleen
kinda sequesters or tucks those platelets away and can keep up to 90% of them in splenomegaly.
Now, to the opposite problem, thrombocytosis. We might have an elevated platelet count.
Acute lymphoblastic leukemia; sometimes, patients will present with higher platelet levels or leukocytosis.
The second one is inflammatory conditions.
If someone has a chronic infection or an inflammatory disease,
their platelet count will likely remain high until the condition is under control.
So, unless they can get that inflammation controlled, the platelet count will likely remain high.
In most cases, if they can get that inflammation under control,
their platelet count will go back to normal.
The third example is acute blood loss.
Now, when you have acute blood loss, as a compensatory mechanism,
the body will release the stores from the spleen.
It's responding to that acute blood loss, trying to clot that with platelets.
The fourth example is iron deficiency.
Patients with iron deficiency can sometimes have their platelet count affected.
Now, most patients with iron deficiency will have normal or elevated platelet counts.
Thrombocytopenia in association with iron deficiency is relatively rare.
The fifth example is polycythemia vera. They may hear this refer to in literature as PV.
PV patients typically experience an elevated leukocyte, a white blood cell count,
an elevated platelet count and an enlarged spleen
especially as the disease progresses over a period of time.
The last example is hyposplenism.
Now, if the patient demonstrates persistent thrombocytosis and they have recurrent infections,
this maybe an indication of hyposplenism.
So, keep in mind, persistent thrombocytosis raises the possibility of the patient having hyposplenism.
Okay, we just looked at low and high platelets.
So, let's break this down a little bit more when it comes to elevated platelets.
Often times patients don't experience any major symptoms with an elevated platelet count,
but I wanna go one step further with you. Let's look at primary thrombocytosis and secondary thrombocytosis.
Now, primary thrombocytosis can cause some really serious bleeding or clotting complications
but it's less common than secondary thrombocytosis.
Secondary thrombocytosis is caused when an underlying process causes the elevation of these, right?
So, that means they've had some kind of treatment or infection or they're recovering from surgery, etc.
So, you will see secondary thrombocytosis more often than primary.
Now, what are the risks of low platelet levels?
We introduced you to the concept of that, now I want to give you a little bit more information on that.
Patients with thrombocytopenia will have unusual bleeding.
Okay. That's the most important point.
This is what you'll see more often in your practice is low platelet levels.
So, I want to make sure you have this very clear before we move forward.
Thrombocytopenia puts your patient at risk for bleeding.
It might be minor, something like unexpected bruising, you might see petechial,
those little tiny blotches that you see on patients' skin.
You might have bleeding from their nose or gums.
Now, I'm gonna keep going through this list
but there's an important patient education point I want you to think about.
If you have a patient who's at risk for increased bleeding, for any reason,
they might be on an anti-coagulant, an anti-platelet, any type of medication
that will impact the patient's bleeding issues, you wanna make sure they understand
what the signs are that they're in trouble.
So, instead of just saying, "Hey, if you notice any unusual bleeding, let us know."
You wanna be very specific with your patients and help them know.
"Hey, if you notice that you're bruising more easily than you usually do, please, let us know.
If you notice any bleeding from your nose or gums," get the idea.
You have to very specific with patients.
Most patients want to be compliant, I know, sometimes it seems like they don't.
But most patients want to be compliant, they just don't understand
and when you're educating them, you have to think
and make sure that you're breaking it down very clearly for them to understand.
Extra bleeding doesn't just mean that they're hemorrhaging blood from their nose.
It can be small things, like the bruising, the petechia, they notice
when they brush their teeth that their gums bleed a lot more;
they might have an unusually heavy menstrual period;
they might notice a change in the color of their bowel movements,
it could be black or frank blood; they might find blood in their urine;
or, they're throwing up and notice blood in their vomit;
or, they could have a severe headache.
Now, think that one through, that is a major sign, okay.
If someone has low platelets, we know they're at an increased risk for bleeding,
and they have a severe headache, unusual from what they normally have,
they could be bleeding into their head. That's a critical emergency.
So, in the upper left we've got some unexpected bruising, not a big deal.
Lower right, you've got something that could be potentially life-threatening.
So, make sure when you're educating your patients, that you don't go too quickly.
You know, when you're sitting in class and the brbrbrbrbr,
and your instructor's talking like that and you just kinda nod your head.
That's what you don't wanna do to your patients.
You wanna make sure you slow down, ask them to make sure they can teach it back to you.
That they can say, 'Okay, help me understand what you understand about what we just discussed.'
That could save somebody's life someday.
Remember, those symptoms range from mild to severe.
So, your role in educating your patients is critically important.
Okay, now let's break this down into some of the smaller points.
MPV is the mean platelet volume.
Now, this is calculated. It's the calculated measurement of the mean platelet size.
So, platelet size often increases with increased production.
So, we report it, but we don't actually use it in practice.
So this is just an FYI slide, not one that I would invest a lot of brain energy in memorizing.
But here's the intuse when someone has an increased MPV,
they might have immune thrombocytopenic purpura,
they might myeloproliferative disease or they might have pre-eclampsia.
Decreased MPV could be a sign of aplastic anemia, cytotoxic drug therapy,
that's like chemotherapy, 'cyto' means cell, 'toxic' means killer,
so cytotoxic drug therapy is usually chemotherapy; or, some viral infections.
Okay, so in case you tuned out, because I said we don't often use this.
I wanted to make sure I put it in here though so you understood if you notice an increased MPV,
these could be the causes or decreased MPV.