Initiаl Pоst оn Types оf Thrombocytopeniа Introduction Thrombocytopeniа is a disease that is characterized by a low amount or abnormal functionality of platelets in the blood. A deficiency of platelets in the blood is defined as less than 150,000 platelets per microliter (National Heart Lung and Blood Institute, 2022). Due to this deficiency, the blood does not clot properly and there can be issues with excessive bleeding. The body’s platelet count can diminish due to problems with the production mechanisms, destruction of platelets in the bloodstream or by organs such as the spleen and liver. There are several different types of thrombocytopenia, each with different etiologies and treatments. These types include Thrombotic Thrombocytopenic Purpura (TTP), Drug-Induced Thrombocytopenia (DIT), Heparin-Induced Thrombocytopenia (HIT), and Immune Thrombocytopenia (ITP). These types of thrombocytopenia are all related because they involve a deficiency of blood platelets. Etiology and Genetic Risk Thrombotic Thrombocytopenic Purpura (TTP) is caused by small blood clots that block blood flow to the major organs of the body. The specific etiology of TTP originates from a deficiency of the enzyme ADAMTS13 that regulates the production of blood clots (National Heart, Lung and Blood Institute, 2022). This deficiency can be genetically passed down, or the enzyme can be destroyed by infection from a different disease, causing an excess amount of blood clots to stop blood flow which can create problems with organ function. The spleen is typically the organ responsible for destroying the ADAMTS13 enzyme (National Heart Lung and Blood Institute, 2022). Drug-Induced Thrombocytopenia (DIT) is caused by drugs that destroy platelets or prevent their production. These drugs can be medications that are meant to help with another disease, but cause clotting issues as side effects. The most common type of DIT is Heparin-Induced Thrombocytopenia (HIT), according to Gersten, 2022. HIT is caused by intake of heparin. Heparin is a blood thinner that specializes in decreasing the formation of blood clots. “HIT is caused by platelets clumping due to an immune reaction to heparin. The clumping uses them up and lowers the count” (EBSCO Medical Review Board, 2022). Although heparin is supposed to decrease the risk of blood clots, with HIT the heparin can cause a severe increase in blood clot production (EBSCO Medical Review Board, 2022). Immune Thrombocytopenia (ITP), is a disorder where the immune system malfunctions and makes antibodies that destroy platelets instead of protecting them. Platelets are usually destroyed in organs such as the spleen and liver, as well as the bone marrow (Schub, 2018). There are two types of ITP, acute and chronic. According to Schub (2018), acute ITP often affects children, whereas chronic ITP is more common in adults. Those with autoimmune disorders or prior infections are more susceptible to ITP. Physical Assessment/Clinical Manifestations The symptoms of each type of thrombocytopenia are similar in some respects, but they differ slightly. With Thrombotic Thrombocytopenic Purpura, severe bruising (called purpura) is common, along with minor, smaller bruises (petechiae). Fever, nausea, fatigue, headaches, high heart rate, jaundice and blood in the urine are other possible symptoms (National Heart Lung and Blood Institute, 2022). For Drug-Induced Thrombocytopenia, the symptoms include purpura and petechiae, as well as “abnormal bleeding” (Gersten 2021). With Heparin Induced Thrombocytopenia, the symptoms of DIC apply, as well as having a list of its own symptoms. These include hypertension, tachycardia, chest pain, coughing and wheezing, fever and pain or swelling in the extremities (Gersten 2021). The symptoms of Immune Thrombocytopenia include “purpura, menorrhagia, epistaxis, gingival bleeding, dependent region petechiae, and retinal hemorrhages” (Schub 2018). All the types of thrombocytopenia mentioned include some form of bruising and excessive bleeding as symptoms. Hemorrhage can be a serious complication to this disease because of the blood’s inability to clot. Clinical Practice Standards In order to diagnose thrombocytopenia, a complete blood count (CBC) must be ordered to confirm the number of platelets in the blood, as well as blood clotting tests such as PTT and PT (Gersten, 2022). TTP can be diagnosed by ordering an ADAMTS13 assay to determine the status of the ADAMTS13 enzyme. Other tests include bilirubin, bone marrow, kidney function and urine tests (National Heart Lung and Blood Institute, 2022). Treatment for TTP includes plasma treatments such as plasmapheresis and plasma infusion, as well as surgeries such as a splenectomy. Medications, such as corticosteroids, can also be used to treat TTP. For DIT and HIT, the diagnosis just includes the blood tests previously mentioned. In addition to those blood tests, a PF4 antibody test is also an effective way to diagnose these types of thrombocytopenia. With regards to treatment, the easiest way to treat these types of thrombocytopenia is to stop taking the medication causing the blood platelets to diminish (Gersten, 2021). ITP can be diagnosed by ordering an MAIPA assay, CBC, coagulation studies, and bone marrow analysis on patients over 60 years of age (Schub 2018). Treatments for ITP include platelet transfusions, medications, or a splenectomy. These treatments are similar to the other types of thrombocytopenia because each type causes the same deficiency of platelets. To determine effective treatment, however, it is crucial that a healthcare provider choose whether to treat the cause or the effect (or both) of the disease. Conclusion Thrombocytopenia is a blood disorder that involves a deficiency of blood platelets. Due to this deficiency, blood clots are unable to form, causing excessive bleeding, bruising and other, possibly fatal, complications. The different types of thrombocytopenia are thrombotic thrombocytopenic purpura, drug-induced thrombocytopenia, heparin-induced thrombocytopenia and immune thrombocytopenia. References EBSCO Medical Review Board. (2022, February 1). Heparin-induced Thrombocytopenia. EBSCOhost. Retrieved March 4, 2023, from https://web-s-ebscohost-com.ezproxy.fhu.edu/nup/detail/detail?vid=0&sid=7155934c-c146-41d6-b2dd-4d1877dbeb8d%40redis&bdata=JnNpdGU9bnVwLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=nup&AN=2010319632&anchor=ID0E2Links to an external site. Gersten, T. (2021, July 22). Drug-Induced Thrombocytopenia. Medline Plus. Retrieved March 4, 2023, from https://medlineplus.gov/ency/article/000556.htmLinks to an external site. Gersten, T. (2022, January 25). Thrombocytopenia. Medline Plus. Retrieved March 4, 2023, from https://medlineplus.gov/ency/article/000586.htmLinks to an external site. Kuter, D. (2022). Overview of Platelet Disorders. Merck Manual. Retrieved March 4, 2023, from https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/overview-of-platelet-disorders?query=thrombocytopeniaLinks to an external site. National Heart Lung and Blood Institute. (2022, March 24). Platelet Disorders. Retrieved March 4, 2023, from https://www.nhlbi.nih.gov/health/thrombocytopeniaLinks to an external site. Schub, T. (2018, February 23). Immune Thrombocytopenia. EBSCOhost. Retrieved March 4, 2023, from https://web-s-ebscohost-com.ezproxy.fhu.edu/nup/detail/detail?vid=0&sid=9e64197f-b348-426e-81ba-38eeb62ec2cd%40redis&bdata=JnNpdGU9bnVwLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=T702280&db=nupLinks to an external site.
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