3. CASESTUDY
• CASE STUDY :DENGUE FEVER WITH
THROMBOCYTOPENIA in a 24 years old male
Patient presentation
• Mr. Abhiyash 24 years old male ,presents to the emergency department
with complaints of high grade fever associated with chills and h/o nausea,
not relieved after taking medication. Admitted under Dr. Mithil sir further
medical management in RK WING on17-3-2024 at 7:40pm
• Mr. Abhiyash is not having past medical and surgical history.
Clinical examination
• Vital signs :stable
• Physical examination: On physical examination there is no symptoms
• Sent the necessary samples as per doctor advise.
4. Follow up :
• Mr abhiyash under went necessary investigations
• Sent the blood samples as per doctor advise.
• He was experience a gradual improvement in platelet counts with
corticosteroids therapy, antibiotics and remains asymptomatic for
bleeding complications, and fever.
7. THROMBOCYTOPENIA
Thrombocytopenia is a condition that occurs
when the platelet count in the blood is too low.
Platelets are tiny blood cells that are made in
the bone marrow from larger cells.
When injured, platelets stick together to form a
plug to seal the wound. This plug is called a
blood clot. Platelets are also called
thrombocytes, because a blood clot is also
called a thrombus.
8. symptoms
Bleeding causes the main symptoms of thrombocytopenia.
Symptoms can appear suddenly or over time. Mild
thrombocytopenia often has no symptoms. Many times.
Possible symptoms include:
• Severe bruising or bleeding
• Small red or purple spots (petechiae) on the skin
• Bleeding gums
• Nosebleeds
• Bleeding from a wound that stops and starts again
• Bloody urine or stool
• Heavy menstrual flow
11. CAUSES
• Platelets and other blood cells are made in
the bone marrow. This is the soft, spongy part
inside bones. Thrombocytopenia can result when:
• The bone marrow doesn't make enough platelets
• Platelets are destroyed by the body at a rate faster
than they can be made in the bone marrow
• Platelets become trapped in an enlarged spleen
12. Cont...
• Certain medicines, such as some types of antibiotics,
antiseizure medicines, and chemotherapy medicines
• Certain viral infections, such as varicella (chicken pox),
HIV, and Epstein-Barr virus
• Certain immune problems, such as lupus and immune
thrombocytopenic purpura (ITP)
• Certain conditions that can cause an enlarged spleen,
such as cirrhosis and cancer
• Alcohol abuse
• Pregnancy
13. Pathophysiology
The pathophysiology of thrombocytopenia involves a disruption in the
production, survival, or function of platelets, leading to a decreased
platelet count in the blood. Here's an overview of the key
mechanisms involved:
1. DECREASED PRODUCTION:
Bone Marrow Disorders: Conditions such as aplastic anemia,
myelodysplastic syndromes, and leukemia can impair the production
of platelets in the bone marrow.
Nutritional Deficiencies: Inadequate intake of nutrients essential for
platelet production, such as vitamin B12 and folate, can lead to
thrombocytopenia.
Chemotherapy and Radiation: Cancer treatments can suppress bone
marrow function, resulting in decreased platelet production
14. 2.INCREASED DESTRUCTION:
Immune Thrombocytopenia (ITP): Autoimmune
destruction of platelets by antibodies, typically against
glycoprotein's on the platelet surface, leading to their
premature removal by the spleen.
Drug-Induced Thrombocytopenia: Certain medications,
such as heparin, quinine, and some antibiotics, can induce
an immune response resulting in platelet destruction.
Infections: Viral infections like HIV, hepatitis C, and
Epstein-Barr virus can cause immune-mediated
destruction of platelets.
Disseminated Intravascular Coagulation (DIC):
Widespread activation of coagulation pathways in
conditions such as sepsis, trauma, or obstetric
complications can lead to consumption of platelets and
subsequer bocytopenia.
15. Coagulation (DIC): Widespread activation of coagulation pathways in
conditions such as sepsis, trauma, or obstetric complications can lead to
consumption of platelets and subsequent thrombocytopenia.
3.Sequestration:
Enlarged Spleen (Splenomegaly): Conditions like cirrhosis, certain cancers,
and hematologic disorders can cause an enlarged spleen, leading to
sequestration and destruction of platelets.
4.Altered Platelet Function:
Thrombocytopathies: Inherited or acquired disorders affecting platelet
function can result in impaired platelet aggregation and adhesion, leading to
a bleeding tendency despite a normal platelet count.
Understanding these underlying mechanisms is crucial for diagnosing and
managing thrombocytopenia effectively, as treatment approaches may vary
depending on the specific cause and pathophysiological processes involved.
16.
17. DIAGNOSIS
• Physical examined.
• Blood Tests will be done to confirm the problem as well. These may
include:
• A complete blood cell count (CBC): This test measures the
amounts of the different types of cells in the blood. This includes the
number of platelets in the blood platelet count).
• A blood smear: This test checks for the different types of blood
cells in the blood and how they appear. A sample of blood is spread
on a glass slide and viewed under a microscope. A stain is used so
the blood cells can be seen.
• A bone marrow aspiration and biopsy: This test checks for
problems with how the bone marrow makes blood cells. A needle is
used to remove a sample of the bone marrow in hipbone. The
sample is then sent to a lab to be tested for problems.
18. MANAGEMENT
Treatment of the underlying cause: For instance, if a
medicine is the cause, it may be stopped or changed.
Platelet transfusions: These help raise the number of
healthy platelets in the body.
Blood transfusions: These help treat blood loss that may
because of low platelets.
Medicines: These may be given to help prevent platelets
from being destroyed. These may also be given to help the
bone marrow make more platelets.
Surgery to remove the spleen: The spleen helps filter the
blood. It also stores some blood cells, including platelets.
When thrombocytopenia is caused by ITP, platelets become
trapped in the spleen. If ITP is not controlled with medicine,
removing the spleen can be an effective treatment.
19. NURSINGMANAGEMENT
1. Assess for potential for bleeding : monitor
platelet count
2. Assess for bleeding
3. Instruct patient and family about ways to
minimize bleeding
4. Initiate masseur to minimize bleeding
5. When platelet is count less then 20000/micro’l
• Keep the bedside rails
• Platelets transfusion as prescribe.
• Caution against force full nose blowing.
20. Conclusion:
• Conclusion:
• This case highlights the clinical presentation,
diagnostic approach, and management of
thrombocytopenia in an adult patient.
• Here we seen introduction, definition,
Symptoms, Causes, Pathophysiology, medical
Management and nursing management.
•
