thrombocytopenia case study clinical case of thrombocytopenia

1. ClinicalPharmacy Semester 10th
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Thrombocytopenia
 Thrombocytopenia is a condition in which you have a low blood platelet
count. Platelets (thrombocytes) are colorless blood cells that help blood clot.
Platelets stop bleeding by clumping and forming plugs in blood vessel
injuries.
 Thrombocytopenia might occur as a result of a bone marrow disorder such as
leukemia or an immune system problem. Or it can be a side effect of taking
certain medications. It affects both children and adults.
 Thrombocytopenia can be mild and cause few signs or symptoms. In rare
cases, the number of platelets can be so low that dangerous internal bleeding
occurs. Treatment options are available.
Symptoms
 Easy or excessive bruising (purpura)
 Superficial bleeding into the skin that appears as a rash of pinpoint-sized
reddish-purple spots (petechiae), usually on the lower legs
 Prolonged bleeding from cuts
 Bleeding from your gums or nose
 Blood in urine or stools
 Unusually heavy menstrual flows
 Fatigue
 Enlarged spleen

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Diagnosis
The following can be used to determine whether you have thrombocytopenia:
 Blood test. A complete blood count determines the number of blood cells,
including platelets, in a sample of your blood.
 Physical exam, including a complete medical history. Your doctor will look
for signs of bleeding under your skin and feel your abdomen to see if your
spleen is enlarged. He or she will also ask you about illnesses you've had and
the types of medications and supplements you've recently taken.
.Treatment
 Blood or platelet transfusions. If your platelet level becomes too low, your
doctor can replace lost blood with transfusions of packed red blood cells or
platelets.
 Medications. If your condition is related to an immune system problem, your
doctor might prescribe drugs to boost your platelet count. The first-choice drug
might be a corticosteroid. If that doesn't work, stronger medications can be used
to suppress your immune system.
 Surgery. If other treatments don't help, your doctor might recommend surgery
to remove your spleen (splenectomy).
 Plasma exchange. Thrombotic thrombocytopenic purpura can result in a
medical emergency requiring plasma exchange.

3. ClinicalPharmacy Semester 10th
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Student Name: Date: 4/26/2021
Patient Demographics:
Name: XYZ Age: 55 years Gender: male Ht/Wt: 75 kg
Chief Complaint:
A 55-year-old man presented with a scalp laceration and T3 and T12 compression fractures
after falling down an escalator. He had a prolonged stay complicated by confusion, pain and
methicillin-sensitive Staphylococcus aureus bacteremia.
Past Medical History;
The patient’s medical history was significant for hepatitis C, hypertension and bilateral knee
replacements requiring red cell transfusions, but no prior thrombocytopenia.
Heavy alcohol use, but had been sober for two years.
Diagnosis:
Drug induced thrombocytopenia
VITAL SIGNS
SIGNS 1 Normal Comment
BP 160/80 120/80 Slightly raised
Temp 970F 960F afibrile
RR
PR 102 Raised
RIPHAH INTERNATIONAL UNIVERSITY
Riphah Institute of Pharmaceutical Sciences
PHARMACOTHERAPY REVIEW (Patient Case)

4. ClinicalPharmacy Semester 10th
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LAB TEST INTERPRETATION
Lab Tests value Normal range INTERPRETATION
RBC 4.41 4.0-5.5*10^6/ul Normal
Hb 10 g/dL 11.5-16.0g/dl Low
HCT 26 36-46% decrease
Platelet 200,000 k/mcL 150-450 *10^3/ul normal
WBCS 13 g/dL 4-11.0*10^3/ul
MCH 19 27-32pg decrease
MCV 92 mcm3 76-96fl decrease
K+
Ca
d-dimer: 7,900
Fibrinogen: 600mg/dl
200 to 400
mg/dL
Normal
Bilirubin 3.4 U/L
ALP
ALT 25 U/L
Albumin 2.2 g/dL
Heparin-induced
thrombocytopenia
(HIT) antibody
Positive
Rx
Nafcillin Furosemide
Quinine (Quinine, AR Holding) Haloperidol
Enoxaparin (Lovenox) Metoprolol
Heparin flushes Morphine
Omeprazole Aspirin
After this therapy lab findings were
 Peripheral smear revealed normochromic and normocytic anemia with increased red
cell regeneration,
 Mild leukocytosis with left-shift,
 Mild absolute eosinophilia,
 Hemophagocytosis and marked
 Thrombocytopenia with large hypergranular platelets

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Labs were drawn. Enoxaparin and quinine were discontinued, and nafcillin was
switched to clindamycin. The patient was started on dexamethasone 40 mg orally
daily for four days.
By day three he had minimal response to dexamethasone. He was started on IV
immunoglobulin 0.4 g/kg for five days. He was also given IV methylprednisone
(Medrol, Pfizer) 500 mg daily for three days.
The platelet antibody to human platelet alloantigen-5a (HPA–5a) was identified. The
diagnosis of post transfusion purpura was made.
The patient received transfusions with 5a negative platelets on three separate
occasions with a platelet bump from 3,000 k/mcL to 21,000 k/mcL.
By hospital day 40 the patient’s platelet count gradually increased, returning to levels
of 70,000 k/mcL

6. ClinicalPharmacy Manual Semester 9th
PRESCRIPTION ANALYSIS FORM
Dr. Name XYZ
Specialization MBBS, FCPS
Patient Name XYZ
Age 55 years
Weight 75kg
Diagnosis Drug induced thrombocytopenia
Other Details (If any) NO
SuggestedCorrections in
Prescription (Missing Name,
Age, Wrong strength, dose,
frequency, etc..)
Duration was not mentioned.
Brands was not mentioned
R IP HAH IN T E R NATIONAL UN IVE R S ITY
Riphah Institute of Pharmaceutical Sciences

7. ClinicalPharmacy Manual Semester 9th
Rx Dosage
Form
Brand Generic Strength Class Frequency Duration Instructions
Nafcillin
Not
mentioned
in the case
Nafcillin
Not
mentioned
in the case
β-lactam
antibiotic
Not
mentioned
in the case
3 days
(after that
r)
Not
mentioned in
the case
Quinine Quinine
(Quinine, AR
Holding)
Antimalarials 3 days
(after that
–
withrawn)
Enoxaparin Lovenox Enoxaparin
(Lovenox)
- low molecular
weight heparins
Heparin flushes Heparin
flushes
- anticoagulant
Omeprazole Omeprazole Proton-pump
inhibitors
Furosemide Furosemide Loop diuretic

8. ClinicalPharmacy Manual Semester 9th
Haloperidol Haloperidol Typical
Antipsychotics
Metoprolol Metoprolol selective β1
receptor blocker
Morphine Morphine Opioid analgesic
Aspirin Aspirin Analgesic,
antiplatelet

9. ClinicalPharmacy Manual Semester 9th
DRUG INTERACTIONS ANALYSIS FORM
Software Drug Interactions Effects
Medscape

10. ClinicalPharmacy Manual Semester 9th