thrombocytopenia ppt for nursing students

Fahey VA. Heparin-induced thrombocytopenia. step 1 assessment - collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about … Schematic representation of the origin and development of megakaryocytes : - The pluripotential stem cell produces a progenitor cell committed to megakaryocyte differentiation (Meg-CFC) which undergoes mitosis. "Inherited" means your parents pass the gene for the condition to you. HIT can be of 3 types based on the time of onset. There is wide variability in sensitivity and specificity. For patients with hepatic impairment, the dose should be reduced to 0.5  g/kg/min. Thrombocytopenia is diagnosed when platelet counts fall under 100,000 per milliliter of blood. higher risk of heart disease a list of biochemistry and there was some specific function. Warkentin TE, Kelton JG. The initial eltrombopag pretreatment resulted in significant increases in platelet counts at Week 4 in all treatment groups. 3 All forms of heparin should be discontinued in the presence of HIT. Platelets stop bleeding by clumping and forming plugs in blood vessel injuries.Thrombocytopenia often occurs as a result of a separate disorder, such as leukemia or an immune system problem. This is usually a side effect of another disease process such as leukemia and some immune system disorders, or the … If you continue browsing the site, you agree to the use of cookies on this website. Platelets (thrombocytes) are colorless blood cells that help blood clot. The study enrolled 74 patients with evidence of liver damage, which was characterized as a liver biopsy indicating chronic hepatitis and cirrhosis or radiographic evidence of cirrhosis or nonbleeding gastroesophageal varices and compensated liver disease (Child-Pugh A). 1995;13(4):112-116. See our User Agreement and Privacy Policy. 1 , 10 , 12 In the case reported here, olanzapine would not have been discontinued if an early distinction between pseudothrombocytopenia and drug-induced immune thrombocytopenia had been made. Patients who met these criteria received antiviral therapy plus eltrombopag for an additional 12 weeks. 1. Nevertheless, limited clinical experience suggests that fondaparinux may be an alternative for anticoagulation in patients with HIT. They decided that of the two fellows, the one whose blood type matched the patient's would receive 500 ml of her blood. The anticoagulant heparin is used in more than 12 million patients per year 1 for treating and preventing thromboembolic disorders in medical and surgical patients. The smaller von Willebrand factor forms that circulate after cleavage do not induce the adhesion and aggregation of platelets during normal blood flow. Steroid added as well. The uncleaved multimers induce the adhesion and aggregation of platelets in flowing blood. The nurse should be aware of how the drug works, why it is ordered, nursing implications, signs and symptoms of an adverse reaction (example: Heparin-induced thrombocytopenia … This slide kit is primarily concerned with immune-mediated thrombocytopenia, or HIT, which occurs in up to 1% to 3% of patients receiving unfractionated heparin and in up to 2% of patients undergoing orthopedic surgery receiving low molecular weight heparin (LMWH). Morbidity and mortality are significant in patients with HIT despite discontinuation of heparin therapy. The answer: She's using NURSING.com videos to supplement the classroom with clear, concise, and to-the-point lectures taught by practicing nurses. Pre-test probabilty must be estimated by using 4T score. Sometimes the cause of thrombocytopenia … Or it can be a side effect of taking certain medications. Here you will find the most popular and creative Free Education Powerpoint Templates that will just blow students minds away. If argatroban infusion rate is >2mcg/kg/min  reduce dose to <2mcg/kg/min first and then, measure inr after 4 hours – now, if INR > 4, can stop argatroban, Why less than 100k : A prospective cohort of healthy subjects with platelet counts between 100 and 150 x 10 9 /L had a 10-yr probability of developing persistent platelets counts < 100 x 10 9 /L of only 6.9% . Thrombocytopenia Nursing Management But however as a result of hormones in high quality all through detoxing and killing part of the cold. 3 The early symptoms of venous thrombosis may not be obvious. Note that in citrate blood, platelet count remains normal in Abciximab related PTCP ( in contrast to true abciximab TP, where platelet clumps are not seen in EDTA smear and platelet counts are low in citrate blood smear as well), WHEN REQUIRED PLATELETS COME OUT OF THE SPLEEN, PNH can lead to drop in all cell lines if the mutation occurs in stem cells instead of red cell precursor alone. ( Note that even in EDTA blood pseudo-thrombocytopenia recovers 3 days after the bolus as abciximab effect on GP Iib/IIIA wears off). Typical HIT occurs between 5 to 14 days after exposure to heparin. Your body may not be making enough platelets, or it may be … Nursing Diagnosis for Thrombocytopenia | Healthfully. Consumption of clotting factors will cause prolonged PT, PTT and reduced fibrinogen. When urgent increase needed always IVIG vs. Anti D, 1. Although clinical experience with this agent in the setting of HIT is limited, the successful use of fondaparinux in patients with HIT has been reported. There are many factors that can cause thrombocytopenia. Clinical manifestations may include venous or arterial thrombosis, necrotic skin lesions at heparin injection sites, or acute systemic reactions subsequent to IV heparin bol… In severe thrombocytopenia, a bone marrow study shows the number, sizes, and cytoplasmic maturity of the megakaryocytes (bone marrow cells that release mature platelets); the study may show ineffective platelet production as the cause of thrombocytopenia … You can change your ad preferences anytime. Unformatted text preview: HAEMATOLOG Y& ONCOLOGY NURSING LEARNING OUTCOME • At the end of this module the students will be able to: • List the common problems related to altered haemopoeitic functions.• Use the nursing … Within a few hours after receiving the woman's blood, Harrington's platelet count dropped. Now customize the name of a clipboard to store your clips. Early onset HIT can occur with in 5 days of heparin re-exposure and is due to pre-existing circulating anti-PF4 antibodies due to prior recent exposure to heparin in the past 3 months ( the antibodies can exist up to 90 days after initial exposure to heparin). At this time, use of fondaparinux in the setting of HIT is not recommended by the American College of Chest Physicians. Bleeding can be external or internal, with bleeding … Heparin-induced thrombocytopenia in patients treated with low- molecular-weight heparin or unfractionated heparin. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Nurseslabs.com is an education and nursing lifestyle website geared towards helping student nurses and registered nurses with knowledge for the progression and empowerment of their nursing careers. ( does not belong to class of direct thrombin inhibitors) The combination of once-daily subcutaneous administration, predictability of response, and minimal adverse effects makes fondaparinux an appealing alternative anticoagulant for patients with HIT. 1999;19(2):181-195. Consumption of plats cause thrombocytopenia that can lead to bleeding complications in some cases. Thrombocytopenia in pregnancy is a common reason for hematology consultation. In total, 65% of patients in the 75-mg dose group, 53% of patients in the 50-mg dosing group, and 36% of patients in the 30-mg dosing group were able to complete the 12-week antiviral therapy phase compared with 6% of placebo-treated patients ( P < .001, P not provided, and P = .003, respectively). Thrombocytopenia is when there is a low platelet count and an increased risk of bleeding. Defined in 3 stages: newly diagnosed (< 3 mos), persistent (3-12 mos), and chronic (> 12 mos) [1] Why : Defining patients as acute vs chronic is a retrospective determination; the new stage definitions will allow for better selection of patients for clinical trials. Am J Med. A patient’s ... nursing students, physicians, physicians in training, and patient organisations, all of whom have an ... (PowerPoint presentations… Sepsis is the main cause of thrombocytopenia … Platelet transfusions are not used just because treatment can be started or treatment can be continued with interruption. 5, 15. CAG A strains of H.Pylori are implicated in ITP. Heparin-Induced Thrombocytopenia (HIT): An Overview Key Point: Broad overview of what the presentation will discuss in detail. … Department of Pathology. Dosing for Argatroban is relatively straightforward. A congenital deficiency of ADAMTS 13 activity, or an acquired defect of ADAMTS 13 (such as that caused by autoantibodies or by a change in the production or survival of the protein) can lead to thrombotic thrombocytopenic purpura. 4,5 An alternate anticoagulant should be strongly considered to treat HIT as well as the underlying condition. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. This review discusses the major causes of thrombocytopenia … In a bleeding patient with ITP, give plt transfusion after IVIG . Dose modifications may lower the chances of sustained virological response. In a flip of the genetic coin, Harrington matched. Heparin can cause 2 forms of thrombocytopenia. You can change your ad preferences anytime. THROMBOCYTOPENIA Decreased production Increased destruction Sequestration Pseudothrombocytopenia ITP No treatment (platelets > 10-20K, no major bleeding or bleeding ... – A free PowerPoint PPT … We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. 2 HIT is a serious condition with about 50% of patients at risk of life- or limb-threatening thromboses if they remain untreated. The heparin that is administered forms complexes with PF4  the IgG antibodies that are already present ( from prior sensitization or from de novo formation during this exposure) now react with PF4-heparin complexes to form circulating immune complexes (PF4-heparin-IgG) which then bind to Fc receptors on the platelets thereby, activating the platelets further  leading to further release of microparticles and more PF4 and activation of the coagulation pathways through platelet-derived microparticles thus setting off prothrombotic state. 5. Some patients may have delayed onset HIT which can start as late as 9 days after exposure to heparin and may occur until 40 days after exposure. Various nursing intervention for thrombocytopenia disease is mentioned in the following: Assess the Patient for any signs symptoms of unusual bleeding, such as as- Epistaxis, Hemoptysis, … World's Best PowerPoint Templates - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. Thrombocytopenia is usually moderate, with median platelet counts ranging from 50-80 × 10 9 /L and nadir counts rarely below 20 × 10 9 /L. The condition can be inherited or acquired. Rather, the direct thrombin inhibitors lepirudin and argatroban are recommended as first-line agents. Rx for HIV-TP is HAART and other modalities of ITP rx. Thrombocytopenia should be defined by a platelet count less than 150×10 9 /L. Idiopathic thrombocytopenic purpura (ITP), also known as primary immune thrombocytopenic purpura and autoimmune thrombocytopenic purpura, is defined as isolated thrombocytopenia with normal bone marrow and in the absence of other cause… HIT can occur up until 30 days even after stopping heparin due to circulating antibodies. 1. Inclusion criteria included presence of thrombocytopenia at platelet counts of 20,000-70,000 cells/µL, whereas patients were excluded for a history of thrombosis, HIV infection, or active hepatitis B virus infection. 1995;332(20):1330-1335. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. This is probably secondary to tiny platelet aggregates. DIC can be better called as consumption coagulopathy – there is activation of entire coagulation cascade with deposition of fibrin thrombi in the vessels that can lead to thromboses of small and mid size vessels  multi organ failure and also, MAHA. 2. Rx HCV-TP discussed earlier. These are all disorders that are generally immune related and can be associated with an ITP-like syndrome or secondary ITP. Although pseudothrombocytopenia has no pathologic significance and will not increase thrombotic or hemorrhagic risk, failure to recognize it may potentially place a patient in jeopardy for inappropriate discontinuation of the needed drug, delay of therapies involving invasive procedures, or initiation of unnecessary therapies, such as platelet transfusion or use of steroids. What is Thrombocytopenia Thrombocytopenia refers to decrease in the number of platelets in peripheral blood below normal (<1.5 lacs/cumm). This condition can also result in spontaneous hemorrhage if platelet counts drop below 20,000. Winner of the Standing Ovation Award for “Best PowerPoint … Idiopathic Thrombocytopenia Purpura (ITP) has two distinct clinical syndromes, manifesting as an acute condition in children and a chronic condition in adults. HIT is classified as two types HIT Type 1 which is non immune mild TP ( >100k) associated with heparin that occurs with in first five days of heparin. Warkentin TE, Levine MN, Hirsh J, et al. The prevalence of kidney transplant is contains unacceptably high levels of estrogens in menopause or for males overly clogged with nursing management of patient with thrombocytopenia … HIT is an immune disease resulting in an extremely pro thrombotic state. If H.Pylori antigen detected, may try h.pylori eradication therapy first before using more toxic therapies. This could turn out to be HCV-related ITP. In a single patient, significant clot extensions or multiple sites of thrombosis may occur. The most common venous thrombotic complication was deep vein thrombosis, which was responsible for more than 60% of thrombotic events in one study, followed by pulmonary embolism, which was responsible for 25% of all events. Thrombocytopenia occurs when your body does not have enough platelets. Clipping is a handy way to collect important slides you want to go back to later. Death can occur in 30% cases if untreated. Criteria for initiation of antiviral therapy with peginterferon and ribavirin included platelet counts of > 70,000 cells/µL for patients receiving peginterferon alfa-2a or > 100,000 cells/µL for individuals receiving peginterferon alfa-2b. Further evidence suggesting that splenomegaly and portal hypertension are not the only factors to explain thrombocytopenia in chronic liver disease is the finding that thrombocytopenia has been shown to endure after surgical portal decompression with transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients. Some infectious causes of ITP are well recognized such as HIV related ITP, HCV and H.pylori. Warkentin TE, Barkin RL. Heparin-induced thrombocytopenia. Drugs can cause thrombocytopenia … One good example is HIT. Since we started in 2010, Nurseslabs has become one of the most trusted nursing … Immune thrombocytopenia can occur in conjunction with a number of other disorders. Thrombocytopenia presenting after 72 hours of age is usually secondary to â ¦ Assess for signs of shock, especially when heavy bleeding occurs. Heparin is an anticoagulant that helps prevent and treat blood clots. Heparin NCLEX questions (anticoagulation) for nursing students! Early-onset and persisting thrombocytopenia in post-cardiac surgery patients is rarely due to heparin-induced thrombocytopenia… See our Privacy Policy and User Agreement for details. See our User Agreement and Privacy Policy. Archer Internal Medicine Board review lectures will be released soon. Interference with the attachment of ADAMTS 13 to endothelial cells in vivo (for example, as a result of ADAMTS 13-receptor blockade by other types of autoantibodies) may also cause thrombotic thrombocytopenic purpura in patients with normal ADAMTS 13 activity in plasma. This is not associated with thrombosis or antibody formation and platelet count recovers despite continuing Heparin. Cells deficient in CD55 and CD59 which protects them from complement mediated destruction. 2 Its importance as an anticoagulant has been well established by its effectiveness, rapid onset of action, ease of laboratory monitoring, and cost. If you continue browsing the site, you agree to the use of cookies on this website. We do the hard work - so you can focus on learning. Flavonoids are often upholstered in plain water (which is … Thrombocytopenia is a condition in which you have a low blood platelet count. Description from List Of Nanda Nursing Diagnosis Thrombocytopenia pictures wallpaper : List Of Nanda Nursing Diagnosis Thrombocytopenia, download this wallpaper for free in HD resolution.List Of Nanda Nursing Diagnosis Thrombocytopenia was posted in February 10, 2015 at 2:00 pm. Now customize the name of a clipboard to store your clips. 1. Patients received 30, 50, or 75 mg/day eltrombopag or placebo daily for 4 weeks. To date, one multicenter, blinded, comparative, in vitro study has demon-strated a lack of cross-reactivity between fondaparinux and HIT antibodies. The Meg-CFC eventually stops mitosis and enters endomitosis during which neither cytoplasm nor nucleus divides but DNA replication proceeds and gives rise to polyploid immature precursor cells. Most cases of TTP occur because of congenital or acquired deficiency of ADAMT13 or secondary to acquired inhibitor to ADAMTS13 – an enzyme that normally cleaves large VWF multimers. Heparin-Induced Thrombocytopenia (HIT) is a prothrombotic adverse drug reaction. If SRA is only 95% sensitive, a negative SRA will nor rule out HIT if clinical, Direct Thrombin inhibitors : argatroban, lepirudin, bivalirudin. Selleng S, Malowsky B, Strobel U, et al. An approach to a patient with Thrombocytopenia, Safety and infection control - Archer NCLEX webinars, No public clipboards found for this slide. If you continue browsing the site, you agree to the use of cookies on this website. This HD Wallpaper List Of Nanda Nursing Diagnosis Thrombocytopenia … Br J Haematol. ( non nuclear particles). An approach to a patient with Thrombocytopenia, No public clipboards found for this slide. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. If you continue browsing the site, you agree to the use of cookies on this website. Hence, even in the absence of hepatitis or overt liver disease, HCV serology should always be obtained in evaluating the patients with ITP before labelling them as idiopathic ITP . 3, 11 Arterial events are generally evidenced by overt clinical symptoms and may be life or limb threatening. ADAMTS 13 may use one of its thrombospondin-1-like domains or its arginine-glycine-aspartate (RGD) sequence to attach to the surface of endothelial cells. Hematology-High Yield Topics For Internal Medicine Boards and Hematology Boards Target Audience: Internal Medicine Residents, Family Medicine Residents, Hematology Fellows, Medical Students, IM Board Recertification exam aspirants Archer Internal Medicine Board Review www.CcsWorkshop.com. Hematology Am Soc Hematol Educ Program. Malvika Tripathi See our Privacy Policy and User Agreement for details. Figure 2. ALPS, autoimmune lymphoproliferative syndrome; APS, antiphospholipid syndrome; CLL, chronic lymphocytic leukemia; CVID, common variable immune deficiency; Hep C, hepatitis C virus; H. pylori, Helicobacter pylori; ITP, immune thrombocytopenia; SLE, systemic lupus erythematosus. Peripheral smear shows clumps in EDTA blood. A rapid decline in platelet count is a sign of poor prognosis, and some committee members felt that the threshold for a poor prognosis should be a decrease of 30% or more in the platelet count. Such practice does not help because transfused platelets will not produce a proper response required and also, their life span is not enough to continue prolonged HCV therapy. Newer strategies for the treatment of heparin- induced thrombocytopenia. Looks like you’ve clipped this slide to already. Although the normal platelet count in humans … Pharmacotherapy. B- and T-cell responses in ITP — B cell autoimmune IgG responses in ITP appear to be driven by CD4+ helper T cells reacting to platelet membrane glycoprotein epitopes - possibly involving CD40:CD40L co-stimulation processes , with splenic macrophages as the major antigen-presenting cells. 1996;101(5):502-507. In the summer of 1950, two hematology fellows working at the Barnes Hospital in St. Louis — William J. Harrington and James W. Hollingsworth — hatched a plan to test their idea that the cause of the idiopathic thrombocytopenic purpura (ITP) in a woman under their care was a factor in the blood that destroyed platelets. Steroids must be used as adjuncts in patients whose platelet count does not increase within several days of treatment with plasma exchange or in those who TP recurs when plasmapheresis is being tapered or discontinued. No dosage adjustment is necessary in patients with renal impairment. Several studies have found increased prevalence of HCV with out overt liver disease in chronic ITP patients between 10 to 30%. So, don't use simple and boring presentations that give students an excuse to … The number of patients able to initiate antiviral treatment ranged from 71% to 91% with eltrombopag vs 22% in the control arm. Looks like you’ve clipped this slide to already. The Food and Drug Administration (FDA) has approved 2 anticoagulants for use in patients with HIT, lepirudin and argatroban. Fondaparinux : Is a INDIRECT inhibitor of Factor Xa. 3 Spurious Thrombocytopenia Source: American Soci ety of Hematology • Thrombocytopenia: abnormally low number of platelets in the peripheral blood ‒Confirmed by peripheral smear review • Differing degrees of thrombocytopenia… After 4 weeks, patients were evaluated before initiation of the antiviral treatment phase of the trial. Our process Each 10 minute lesson takes over 12 hours to create. Nursing Management: Thrombocytopenia Nursing Assessment Subjective and objective data that should be obtained from a patient with thrombocytopenia … Most laboratory tests have long turnaround time and hence, therapy must not be delayed if pretest is high or intermediate. "Acquired" means you aren't born with the condition, but you develop it. While these tests are helpful in confirming HIT, the diagnosis remains a clinical one since there is wide variability of, access to, and turnaround time for these assays. Thrombocytopenia. In Panel B, absent or severely reduced activity of ADAMTS 13 in patients with thrombotic thrombocytopenic purpura prevents timely cleavage of unusually large multimers of von Willebrand factor as they are secreted by endothelial cells. Multiple platelet transfusions can cause platelet refractoriness ( alloimmunization) and also, other transfusion related complications. Useful for Internal Medicine Boards . Maternal thrombocytopenia in pregnancy 2 thrombocytopenia (Table 1). A 14-year study of heparin-induced thrombocytopenia. Students read a brief clinical history of the patient and a description of the relevant signs and … Upon completion of endomitosis, the immature progenitor cells become large, morphologically identifiable mature megakaryocytes  MEGAKARYOCYTE now sheds the platelets. HIT is a clinical diagnosis. 30 – 50% of patients presenting with HIT experience a thrombotic event within 30 days. Low baseline platelets < 70k lead to postponement of therapy. Clipping is a handy way to collect important slides you want to go back to later. J Vasc Nurs . Immune thrombocytopenia is an autoimmune-mediated haematological disorder affecting platelets. The most common causes and differential diagnosis of In-patient and Outpatient presentations of Thrombocytopenia is discussed here. Hematology-High Yield Topics For Internal Medicine Boards and Hematology Boards Target Audience: Internal Medicine Residents, Family Medicine Residents, Hematology Fellows, Medical Students… Greinacher A, Selleng K. Thrombocytopenia in the intensive care unit patient. 2010;2010:135–43. 17 The initial dose of Argatroban is 2  g/kg/min; the mean dose during clinical studies was 2  g/kg/min, indicating dose titration for many patients may not be necessary to achieve adequate anticoagulation. Unexplained thrombocytopenia is a common clinical problem, and the possibility of drug-induced thrombocytopenia must be considered, especially in hospitalized patients. Platelets are cells that help your blood clot. -Pt develops thrombocytopenia 5-10 days after initiation of heparin therapy -HIT should be suspected if platelet count falls by >50% (or below 150,000/µL) -Primary concern: venous or arterial thrombus … Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. HIT occurs due to presence of IgG antibodies that recognize heparin-PF4 complexes. Proposed Relation among the Absence of ADAMTS 13 Activity in Vivo, Excessive Adhesion and Aggregation of Platelets, and Thrombotic Thrombocytopenic Purpura. In this figure taken from a paper by Cines and colleagues published in Blood in 2009, primary ITP encompasses about 80% of all ITP; the other disorders listed in the breakout are all causes of secondary ITP.

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